Painkillers Are Increasingly Prescribed After Low-Risk Surgery

Addiction to painkillers is a growing epidemic in the U.S., fueled in large part by changing ways that doctors are expected to help their patients address pain. In a study published in JAMA, researchers show that the use of painkillers, even after low-risk operations, has increased over the past eight years.

The U.S. and Canadian scientists studied a database of 14 million people who filed insurance claims for medical procedures and drug prescriptions. About 80% of the people filled a prescription for an opioid painkiller within seven days of their surgery for carpal tunnel, hernia, arthroscopic knee repair or gallbladder removal. For each of the procedures, rates of painkiller prescription-filling rose between 2004 and 2012. When the researchers calculated the mean morphine exposure represented by those prescriptions, they found that daily doses of the medications increased over that time period, leading to a rise in morphine levels. Morphine, a narcotic, is the ingredient that can make painkillers habit-forming as it affects reward centers in the brain as well as pain receptors.

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The trend highlights what many experts believe is an over-prescribing of opioid pain medications. In another report in the same issue of JAMA, researchers found that 42% of Medicaid patients getting a tooth extraction filled a prescription for an opioid, including hydrocodone and oxycodone, among the most addictive painkillers on the market. The authors note that the use of opioids in these cases may not always be necessary. “These data suggest that disproportionally large amounts of opioids are frequently prescribed given the expected intensity and duration of postextraction pain, particularly as non-opioid analgesics may be more effective in this setting.”

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Given the growing concern about opioid abuse, much of which begins with prescriptions provided after such low-risk procedures, the authors of both papers agree that patterns of opioid prescriptions should be studied more thoroughly to ensure that doctors consider other effective but less addictive options before turning to opioid pain medications as a default to address patients’ pain.