Potentially lethal opioid drugs are being inconsistently prescribed to patients undergoing elective surgery, according to a study of patients attending a west of Ireland hospital.
One-quarter of patients receiving routine elective surgery at the hospital were prescribed opioid painkillers, according to the study, which highlights a lack of training and guidelines for doctors on the issue.
The death toll from the “opioid crisis” in the US has passed one million and even though Europe has been less severely affected, the number of opioid-related overdoses on this side of the Atlantic is increasing. An estimated 30 per cent of opioid dependency stems from drugs given on prescription when patients are discharged from hospital.
The study, the first Irish research to audit prescribing patterns for these drugs following routine elective surgical procedures, is based on five years of records in a “high-volume single centre in the west of Ireland” which is not named. The study has been published in the Irish Journal of Medical Science.
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It identifies “significant variability” in opioid prescribing patterns following three types of minor, intermediate and major operation, and says these inconsistencies could prove problematic in future efforts to tackle the ongoing opioid crisis.
Women were more likely to be prescribed opioids but patients with other conditions or cancer were no more likely to be given them.
Overall, 24 per cent of the 300 patients were prescribed opioids after their procedure, but this figure varied according to the seriousness of the operation. One-third received non-opioid analgesia and the rest were given no painkillers.
Some 27.8 per cent received opioids after a major surgery (colonic resection), 24.1 per cent after a minor surgery (inguinal hernia repair) and 15.9 per cent after an intermediate procedure (laparoscopic cholecystectomy – minimally invasive gallbladder removal).
Just one of the patients receiving minor or intermediate surgery required treatment in intensive care and the average length of stay was 1.3 days for both categories.
The authors say a “worrying” trend could potentially be developing of over-prescribing and variability in prescribing patterns contributing to global problems around opioids.
Guidelines such as those recently introduced in the US “will prove crucial in stemming the flow of unnecessary opioids into the community from post-operative prescription by surgical teams in future”.
“Particularly in Ireland, it is our view that surgical residents here have not been given any guidelines in this setting.”
