How Common Is Opioid Misuse Among Seniors After Hip Surgery?
Many seniors who undergo surgery after breaking a hip continue to take opioids long after being released from the hospital, new research indicates.
After tracking nearly 30,000 U.S. older patients, investigators found that nearly 17% were still taking opioids as much as half a year after hip surgery. At three months after surgery, that figure was nearly 70%, while almost 84% of the patients were on opioids during the first month following surgery.
The study team said the numbers suggest that older patients struggling with acute pain are not immune to the risk for becoming dependent on an extremely addictive drug.
"While the risk of long-term opioid dependence following musculoskeletal injury and surgery has been established in younger patient populations, our study found that this risk was present in elderly patients following hip fracture surgery as well," said study lead author Dr. Kanu Okike, an orthopedic surgeon with Hawaii Permanente Medical Group in Honolulu.
Okike and his colleagues focused on hip surgery patients aged 60 and up, with an average age of 82. All the patients were surgically treated between 2009 and 2018 at one of 35 hospitals across the United States; roughly 7 in 10 were women.
"Opioid pain medications are powerful agents which can alleviate the pain that many patients experience after hip fracture surgery," Okike acknowledged. In that light, "it is certainly reasonable for patients to take opioid pain medications for the first few days or weeks following hip fracture surgery," he added.
"However, opioid pain medications are also associated with a number of serious side effects," Okike noted. With prolonged use, that can mean nausea, vomiting, sedation, constipation and breathing problems, alongside the risk for developing long-term dependence.
The risk for prolonged opioid use was found to be highest among the youngest patients, women, those who had a history of smoking and/or substance abuse, and those with a higher body mass index (a measure of excess weight).
The researchers will present their findings this week at a meeting of the American Academy of Orthopaedic Surgeons, in San Diego. Such research is considered preliminary until published in a peer-reviewed journal.
Two experts not involved with the study stressed how chronic dependence is potentially a big problem among older pain patients.
"Opioids carry a high risk of addiction," said Linda Richter, vice president of prevention research and analysis with the Partnership to End Addiction. "And when used for a longer period of time the risk of physical dependence on opioids increases, especially for patients with a history of substance misuse or substance use disorder, as this study found."
In addition, Richter stressed that "older patients may be more vulnerable to the adverse effects of opioids, including the risk of addiction, since they typically metabolize drugs more slowly than younger people, and are more sensitive to the effects of drugs like opioids."
Adding to the problem, she noted, is the fact that "health care providers may be less likely to consider or identify a substance use problem in an elderly patient than in a younger patient, potentially mischaracterizing the symptoms of drug misuse as depression or anxiety."
And that, Richter said, could lead to "missing opportunities to help taper patients off addictive medications, provide alternatives, or refer those in need to treatment. The fact that such a high percentage of older patients in this study were prescribed opioids up to six months post-surgery is very concerning."
Such concerns were echoed by Dr. Yili Huang, director of the pain management center at Northwell Health's Phelps Hospital in Sleepy Hollow, N.Y.
"None of these findings are surprising, and just reinforce our current evidence that we should approach opioid use carefully," he said.
Given that "as many as 12% of patients started on opioids for any reason may develop opioid use disorder," Huang said it's important that postsurgical opioid prescriptions be carefully individualized for the type of surgery at hand and tailored for each patient's particular needs.
"The best course of action would be to provide a short course of opioids -- 7-14 days -- and reevaluate pain needs with a follow-up appointment," Huang said.
Meanwhile, Okike stressed there are other effective pain-control options that can be considered, "which can relieve pain without such severe side effects." He pointed to non-opioid painkillers -- such as acetaminophen (Tylenol) or anti-inflammatories such as ibuprofen; nerve-blocking drugs; ice, and routine body repositioning.
There's more on opioid use concerns among the elderly at the U.S. National Institute on Drug Abuse.
SOURCES: Kanu Okike, MD, MPH, FAAOS, orthopedic surgeon, Hawaii Permanente Medical Group, Honolulu; Linda Richter, PhD, vice president, prevention research and analysis, Partnership to End Addiction; Yili Huang, DO, MBA, director, pain management center, Northwell Health's Phelps Hospital, Sleepy Hollow, N.Y.; American Academy of Orthopaedic Surgeons annual meeting, San Diego, Aug. 31-Sept. 3, 2021