A retrospective claims-based cohort analysis of more than 300,000 opioid-naïve patients before ophthalmic surgery between 2012 and 2017 found that exposure to opioids after their surgery was linked to new, persistent use long term.

The analysis, published in Ophthalmology, suggests that patients who had never used opioids before surgery are at higher risk of addiction post-surgery, making exposure to opioids an independent risk factor for persistent use in this group of patients. Persistent use is defined as filling a prescription 90 days after surgery, and then again in the 91-180-day post-operation period. 

"Patients and their families can be impacted if opioids given for post-surgical pain are misused. My initial research interest was in over-prescribing of opioids after corneal procedures," said Maria Woodward, M.D., M.S., lead author of the study and an ophthalmologist at University of Michigan Health Kellogg Eye Center.

Although there's data on who is prescribed opioids after surgery, less is known about the long term effects of these short-term prescriptions.

"Prescribing these medications should be carefully considered by the treating physician. We should share the responsibility with the patients to consider the necessity of an opioid prescription," said Woodward, also a member of the University of Michigan Institute for Healthcare Policy and Innovation. "From a policy standpoint, best practices for prescribing these medications should be developed."

The American Academy of Ophthalmology has created a webpage of safe, opioid prescribing resources for physicians, but not all hospitals may know they can access these, or that they can use this guidance to inspire their own best practices at their respective institutions.

"Clinicians that are prescribing opioids should consider if they've given adequate warning about the dangers of the medication to the patient, taking into consideration their individual pain threshold and history of opioid use," said Woodward. "Are there other pain management options that are better suited for the patient to match the level of pain with the prescribed medication?"

Next steps for Woodward's research team includes studying the barriers that providers face at their institutions to creating best practices for prescribing opioids and tailoring pain prescriptions, so the national opioid crisis can start to be combatted at the foundational level.

Financial Support: This study was funded by the National Eye Institute (R01EY031033), Research to Prevent Blindness and the Career Advancement Award, the Vitreo-Retinal Surgery Foundation Award, American College of Surgeons and the American Foundation for Surgery of the Hand, Centers for Disease Control and Prevention (E20182818-00), Michigan Department of Health and Human Services (E20180672-00), National Institute of Arthritis and Musculoskeletal and Skin Diseases (P50 AR070600), National Institute on Drug Abuse (RO1 DA042859), Substance Abuse and Mental Health Administration (E20180568-000), and the University of Michigan School Dean's Office—Michigan Genomics Initiative and Precision Health Initiative.

Paper Cited: "Persistent Opioid Use after Ophthalmic Surgery in Opioid-Naive Patients and Associated Risk Factors," Ophthalmology. DOI: 10.1016/j.ophtha.2021.04.021