The impact of substance use and abuse on opioid demand in lower extremity fracture surgery.
OBJECTIVES: To describe the perioperative opioid demand in a large population of patients undergoing lower extremity fracture fixation and to evaluate mental disorders such as substance abuse as risk factors for increased use. DESIGN: Retrospective, observational SETTING:: National insurance claims databasePATIENTS/PARTICIPANTS: 23,441 patients grouped by mental disorders such as depression, psychoses, alcohol abuse, tobacco abuse, drug abuse, pre-operative opioid filling undergoing operative treatment of lower extremity fractures (femoral shaft through ankle) between 2007 and 2017. INTERVENTION: Operative treatment of lower extremity fractures. MAIN OUTCOME MEASURES: The primary outcome was filled opioid prescription volume converted to oxycodone 5-mg pill equivalents. Secondary outcomes included the number of filled prescriptions and the risk of obtaining 2 or more opioid prescriptions. RESULTS: Out of 23,441 patients, 16,618 (70.9%), 8,862 (37.8%), and 18,084 (77.1%) filled opioid prescriptions within 1-month pre-op to 90-days post-op, 3-months post-op to 1-year post-op, and 1-month pre-op to 1-year post-op, respectively. On average, patients filled 104, 69, and 173 oxycodone 5-mg pills at those time intervals. Alcohol, tobacco, drug abuse and pre-operative opioid filling were associated with increased perioperative opioid demand. Psychoses had a small effect on opioid demand and depression had no significant impact. CONCLUSIONS: This study reports the rate and volume of opioid prescription filling in patients undergoing lower extremity fracture surgery. Substance use and abuse were the main risk factors for increased perioperative opioid prescription filling. Providers should recognize these risk factors for increased use and be judicious when prescribing opioids. Enhanced patient education, increased non-opioid pain management strategies, and referral for substance use and abuse treatment may be helpful for these patients. LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of levels of evidence.
Cunningham, D; LaRose, M; Gage, M
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