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Misuse of Opioids in Orthopaedic Postoperative Patients
Anup Gangavalli1, Ajith Malige, George Terres
1*Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, PA; †Temple-St. Luke's University School of Medicine, Bethlehem, PA; ‡Temple University School of Medicine, Philadelphia, PA; and §Department of Orthopaedic Surgery, Temple University Hospital, Philadelphia, PA.
Objective:
In light of the recent uptrend in the prescription of opioids, this study seeks to identify patterns of opioid misuse among orthopaedic postoperative patients and principal external sources in obtaining these medications.
Design:
Ten-month survey-based study.
Setting:
Two Level I trauma centers (urban and suburban).
Patients/Participants:
Two hundred seven patients between the ages of 18 and 89 years who underwent surgical fixation of fractures involving the pelvis, long bones, or periarticular regions of the knee, ankle, elbow, and wrist.
Main Outcome Measurements:
Patients who believed they were undermedicated, used prescribed opioids at higher than recommended doses, and took extra opioids in addition to their prescribed analgesics were analyzed by age, employment, income, education, controlled substance use, pain interference with activities of daily living, and anatomic surgical site.
Results:
One hundred eighty-two patients completed the survey; 19.2% of patients (n = 35) felt undermedicated [unemployed (P < 0.05), low income (P < 0.05), and self-reported controlled substance users (P < 0.05)]; 12.6% of patients (n = 23) admitted to using pain medications at a higher dose than prescribed [unemployed (P < 0.05), lower income (P < 0.05), nonhigh school graduates (P < 0.05), and previous controlled substance users (P < 0.05)]; 9.3% (n = 17) admitted to using external opioids [unemployed patients (P < 0.05) and self-reported controlled substance users (P < 0.05)]. Major sources of extraneous opioids include family/friends (n = 5) and other doctors (n = 4).
Conclusion:
Unemployed and lower-income patients were significantly more likely to believe that their surgeon was not prescribing them enough pain medications as well as use their prescribed opioid medications at a higher than recommended dose compared with their employed counterparts with higher incomes. Unemployed patients were also significantly more likely to use additional opioid analgesics in addition to those prescribed to them by their primary surgeon. Surgeon awareness of a patient's socioeconomic background and associated risk of opioid misuse is crucial to prescribe the safest most effective pain regimen.
Level Of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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