Users of chronic prescription opioids decrease in the first 12 months following bariatric surgery

Obesity is an independent risk factor for chronic pain frequently treated with opioids. Our study investigated the effect of Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) on chronic opioid prescription use.

Using the IBM MarketScan database (2010-2017), we analyzed adult chronic opioid users who underwent bariatric surgery. Opioid use was measured in morphine milligram equivalents (MME) for 6-month periods before and after surgery. Changes in MME for each 6-month interval were compared to preoperative exposure and across the different types of bariatric surgery.

Of the 2197 patients identified, 29% discontinued opioids 6 months post surgery, further decreasing to 23.4% at 12 months. Discontinuation rates were similar for VSG and RYGB. Preoperative opioid exposure did not predict postsurgery discontinuation, but patients with multiple opioid prescription types were less likely to stop. Among those continuing opioid use, average MME increased at 6 months post surgery compared with 6 months pre surgery in both groups (mean [SD], RYGB: 49.4 [347.3]; VSG: 74.9 [533.4]).

Although bariatric surgery reduced the number of chronic opioid users by nearly 25%, persistent users showed increased average opioid exposure after surgery. Further research to track long-term opioid use should be conducted, and providers should inform patients of these risks and attempt opioid dose reductions before surgery.