medwireNews: US research has highlighted the risk for continued use of opioids and sedative-hypnotic drugs after mastectomy and reconstructive surgery.
“It has become clear that short-term exposure to opioids for any reason can lead to long-term dependence, given the highly addictive potential of these agents,” presenting author Jacob Cogan (Columbia University Medical Center, New York) told the press at the 2020 San Antonio Breast Cancer Symposium.
“Many patients receive this initial exposure around the time of surgery, and patients with cancer are at particularly high risk of becoming dependent on opioids post-operatively,” he added.
But Cogan noted that the rates of opioid use after mastectomy with reconstruction remain unknown, and there is also not much information about the use of sedative-hypnotic medications, such as benzodiazepines, in this population.
The team therefore drew on the IBM Truven MarketScan database to identify 35,292 women who underwent mastectomy plus reconstruction in 2008–2017 and had not filled a prescription for a controlled drug within 31 to 365 days prior to surgery. Around 98% of the participants received surgery due a breast cancer diagnosis, while the procedure was prophylactic for the remainder.
Following surgery, 13.1% of 25,270 opioid-naïve women and 6.6% of the 27,651 women not previously exposed to sedative-hypnotics became persistent users, defined as filling at least one prescription in the perioperative period (–31 to +90 days of surgery) and at least two prescriptions in the postoperative period (90–365 days after surgery).
A total of 61.8% and 32.4% of patients used opioids and sedative-hypnotics, respectively, solely during the perioperative phase, while the corresponding rates of nonuse (ie, no prescriptions during the perioperative period) were 25.1% and 61.0%.
When the analysis was restricted to individuals who were exposed to the substances perioperatively, the rates of new chronic opioid and sedative-hypnotic use rose to 17.5% and 17.0%, respectively.
Factors significantly associated with new persistent opioid use included Medicaid insurance (odds ratio [OR]=2.31), breast cancer diagnosis (OR=1.44), receipt of chemotherapy (OR=1.33), and age between 50 and 64 years (OR=1.29) or 49 years or younger (OR=1.27) versus age 65 years or older.
The same factors were also significant predictors of new chronic sedative-hypnotic use, but the associated odds were highest for chemotherapy use (OR=2.24) and lowest for an age of 50–64 years (OR=1.65).
Cogan highlighted that the likelihood of opioid use increased with the number of risk factors, rising from an OR of 2.27 for women with two factors to 6.34 for those with five factors. Similarly, the odds of persistent sedative-hypnotic use rose from 2.55 for two factors to 7.71 for five factors.
He acknowledged the limitations of the study, such as the observational design, lack of information on reasons for medication use, and availability of just 1 year of postoperative data.
Nonetheless, the presenter hopes that this analysis “can increase awareness that these are addictive medications, and a brief exposure for surgery-related pain or anxiety can lead to long-term use.”
But Cogan emphasized that the findings do not support avoiding opioids and sedative-hypnotics altogether.
“Rather, patients should be vigilant about taking these medications only when necessary, and they should work closely with the prescribing provider to attempt to minimize risk of dependence,” he concluded.
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