Treating opioid use disorder prior to surgery prevents relapse, overdose

Using medications for the treatment of opioid use disorder (OUD) prior to surgery reduces the likelihood of postoperative overdose in people with a history of OUD. At the recent annual meeting of the American Society of Anesthesiologists, a poster study showed that patients with OUD who didn’t use an OUD medication before surgery had more than four times the risk of overdosing within a year of the surgery. But patients who used OUD treatments beforehand had about the same risk as those with no OUD. “Surgery represents a high-risk experience for individuals with OUD given the likelihood of reintroduction to prescription opioids in the perioperative period. However, it is not yet known how use of (medications for OUD or MOUD) may influence risk of relapse and associated adverse outcomes in surgical patients with OUD,” the poster said. The study was conducted using claims from a commercial database which contained nationwide healthcare data for patients with employer-sponsored and Medicare Advantage insurance. Data were included for patients who underwent any of 25 common major surgeries. Researchers selected patients who had a diagnosis of OUD in the year prior to surgery, and records of whether or not they used MOUD. MOUD was defined using prescription fills for buprenorphine or naltrexone. Methadone was not included because fewer than 5% of OUD patients in the database were treated with it. The primary outcome was overdose in the year following surgery. Data for 2,958,490 surgeries were included. Of these, 23,071 (0.8%) surgeries were performed on patients with a history of OUD, and of these, 11,288 (48.9%) used MOUD. Postoperative overdose in the population was 0.03%; among those with OUD, it was 0.15%, the study said. After adjusting for other factors such as socio-demographic characteristics, comorbidities, and more, it was found that “patients with OUD had 4.7 times the odds of postoperative overdose compared to patients without a diagnosis of OUD. Patients with OUD who used MOUD, however, had 0.25 times the odds of postoperative overdose compared to those who were not on MOUD,” the study said. The researchers concluded that “use of evidence-based medication therapy for OUD was associated with an approximate 75% statistically significant reduction in postoperative overdose. While the overall prevalence of overdose was low, these findings suggest that evidence-based medication therapy for OUD may be an important modifiable factor in preventing relapse and opioid-related adverse events.”

Treating opioid use disorder prior to surgery prevents relapse, overdose

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