Opioid Use Increases in Some Patients for Years after Bariatric Surgery

Published in July/August Issue             

While the proportion of adults with severe obesity using prescription opioids declines in the months after bariatric surgery, its use gradually climbs in the years after the operation, eventually surpassing pre-surgery rates, according to new research from a National Institutes
of Health
(NIH)-funded multicenter study led by the University of Pittsburgh Graduate School of Public Health. The study found that
1 in 5 weight-loss surgery patients are taking opioids seven years after surgery.

According to researchers, the findings suggest that improvements in obesity-related pain gained through bariatric surgery are not sufficient to counter the need for pain relief in the years following the procedure. Results were published in June in Surgery for Obesity
and Related Diseases

“Almost half of patients reporting opioid use at the time of surgery reported no such use following surgery. However, among the much larger group of patients who did not report opioid use pre-surgery, opioid use gradually increased throughout seven years of follow-up,” said lead author Wendy C. King, PhD, associate professor of epidemiology at Pitt Public Health, in a news release. “Thus, post-surgery initiation of opioid use explains this phenomenon.”

Starting in 2006, King and her colleagues followed more than 2,000 patients participating in the NIH-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a long-term prospective observational study of patients undergoing weight-loss surgery at one of 10 hospitals across the United States.

Before surgery, 14.7 percent of the participants reported regularly taking a prescription opioid. Six months after surgery the prevalence decreased to 12.9 percent, but then increased to 20.3 percent of participants regularly taking opioids seven years after surgery. Among those not taking opioids at the time of surgery, rates increased from 5.8 percent six months after surgery to 14.2 percent seven years later. Hydrocodone was by far the most commonly reported opioid medication, followed by Tramadol and Oxycodone.

According to a University of Pittsburgh Health Science news release, some researchers have hypothesized that opioid use increases following bariatric surgery due to discontinuation of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, which are contraindicated post-surgery.

King and her colleagues found that starting NSAIDs post-surgery was associated with a higher risk of also starting to take opioids, while stopping NSAIDs was associated with lower risk of taking opioids.

“There is an urgent need for research into adequate alternatives to opioids for the long-term management of chronic pain following weight-loss surgery,” said King.

The CDC recently presented an evidence-based guideline stating that opioids should not routinely be used to manage chronic pain.

“Our nation is in an epidemic of opioid abuse, addiction and overdose. Recent reports have suggested that bariatric surgery patients are at elevated risk of chronic opioid use,” co-author Anita P. Courcoulas,
MD, MPH, chief of minimally invasive bariatric and general surgery at UPMC (University of Pittsburgh Medical Center), said in a news release. “Our study does not prove that bariatric surgery causes an increase in opioid use. However, it does demonstrate the widespread use of opioids among post-surgical patients, thereby highlighting the need for alternative pain management approaches in this population.”