In May 2018, Governor Hickenlooper signed Senate Bill 18-22 Clinical Practice for Opioid Prescribing. This limits the number of opioid pills a healthcare provider can prescribe and provides an outline for opiate management.
From a surgeon’s perspective, we almost never provide preoperative opioids. After surgery, we try to incorporate ERAS (enhanced recovery after surgery) techniques to minimize postoperative narcotic usage. When opiates are necessary, we try to wean them off quickly.
Some patients, unfortunately, present to their surgeon are already taking opiate medications. A recent 2019 article was published in the journal, Spine Surgery, comparing spine surgery outcomes in patients taking opioids before surgery.
Of the 2,128 patients studied who underwent elective spine surgery, 21% were taking opioids in the 3 months before surgery. In these patients, there was a substantially lower chance of achieving meaningful improvements in pain, function, or quality of life at 1 year following surgery. These patients were also likely to be on chronic postoperative opiates.
This study supports the rapidly growing evidence surrounding the detrimental effects of opioids. While medical providers want patients to be pain-free as quickly as possible, managing pain with opioids may actually diminish the potential benefit of future surgery.
A crucial finding in this particular study was that the negative opioid effect was independent of dosage. It did not matter how much narcotics the patient was taking, it simply mattered that they were taking some.
In another recent study, about 57% of patients undergoing spine surgery had some narcotic exposure. This percentage is likely an underestimate, as some patients pay for prescriptions in cash, which avoids reporting by databases.
Preoperative opioid use, like smoking, may be a major modifiable risk factor for poor outcomes in spine surgery.
Hills J. Preoperative opioids and 1-year patient-reported outcomes after spine surgery.
Spine Surgery, 44(12), 887-895, 2019
Hilliard PE. Prevalence of preoperative opioid use and characteristics associated with
opioid use among patients presenting for surgery. JAMA Surg. 153:9290937, 2018