Studies Begin to Define Extent of Opioid Use and Misuse in Orthopaedics
The opioid epidemic – and its consequences – represents a major health issue in the US, prompting the Centers for Disease Control and Prevention (CDC) to issue guidelines for prescribing opioids for chronic pain. 
“More than 40 Americans die each day from prescription opioid overdoses, we must act now,” said CDC Director Tom Frieden, MD, MPH.
“Overprescribing opioids – largely for chronic pain – is a key driver of America’s drug-overdose epidemic. The guideline will give physicians and patients the information they need to make more informed decisions about treatment.”
Morris and Mir identified orthopaedic surgeons as a significant contributor to the use of opioids, noting that overall, “Orthopaedic surgeons are the third highest prescribers of opioid prescriptions among physicians in the United States.” 
They urged orthopaedic surgeons to “to recognize objective measures to identify patients at risk for nontherapeutic opioid use. These measures include elements of the patient history, recognition of aberrant behaviors, prescription drug monitoring programs, and opioid risk-assessment tools.” 
But just how significant is the problem in orthopaedics? Two recent studies sought to define the extent of persistent use of opioids following orthopaedic surgery. [3,4]
Opioid Addiction and Dependence after Surgery Are Greater than Previously Known
As the opioid epidemic rages on in the U.S., a new study finds that the use of opioids to treat pain after surgery is leading to addiction at alarming rates.
According to a national survey, 1 in 10 patients admit they’ve become addicted to or dependent on opioids after being exposed to these powerful medications following an operation.
With 70 million surgical patients in the U.S. receiving an opioid annually, these findings suggest that as many as 7 million patients could develop an opioid addiction or dependency this year after surgery.
This research sheds new light on the causes of opioid addiction, which until now has primarily been focused on the use of opioids for treating patients with chronic pain. These findings indicate that even prescribing these drugs for short-term postsurgical pain can put patients at serious risk.
The survey polled 500 adults in the U.S. who had an orthopedic or soft tissue surgery in the past 12 months and 200 U.S. surgeons who perform these procedures.
Why Do Patients Continue Using Opioids Months after Joint Replacement?
Many patients undergoing hip or knee replacement are still taking prescription opioid pain medications up to 6 months after surgery, reports a study in PAIN, the official publication of the International Association for the Study of Pain (IASP).
Led by Jenna Goesling, PhD, of the University of Michigan, the study identifies several “red flags” for persistent opioid use, particularly previous use of high-dose opioids.
The results also suggest that some patients continue to use these potentially addictive pain medications despite improvement in their hip or knee pain.
- Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for
- chronic pain — United States, 2016. MMWR Recomm Rep 2016;65:1-52; early release March 15, 2016. Available at http://www.cdc.gov/media/modules/dpk/2016/dpk-pod/rr6501e1er-ebook.pdf; accessed August 1, 2016.
- Morris BJ, Mir HR. The opioid epidemic: impact on orthopaedic surgery. J Am Acad Orthop Surg. 2015 May;23(5):267-71. doi: 10.5435/JAAOS-D-14-00163.
- Pacira Pharmaceuticals, Inc. New research: opioid addiction and dependence after surgery is significantly higher than previously known. Press release; August 1, 2016.
- Goesling J, Moser SE, Zaidi B, et al. Trends and predictors of opioid use after total knee and total hip arthroplasty. 2016 Jun;157(6):1259-65. doi: 10.1097/j.pain.0000000000000516.