Examining the Opioid Crisis: Post-Surgery Risks of Opioid Prescriptions

Post-surgery prescriptions fan the flames of the opioid crisis.

The Opioid Epidemic Reaches New Depths

Opioids have ravaged lives across North America and beyond for over two decades. In Canada alone, there were nearly 51,000 opioid overdose deaths between January 2016 and September 2024. In the first half of 2024, 84% of accidental opioid toxicity deaths in Canada occurred in British Columbia, Alberta, and Ontario, 79% of which involved fentanyl.

In the U.S., more than 645,000 people died from an opioid overdose between 1999 and 2021, "killing more people than HIV/AIDS at the height of the epidemic in 1995," according to Stanford University.

A 2024 study out of McGill University Health Centre, led by Dr. Siyana Kurteva, has shed more light on opioid use following surgery, pointing to a need to rethink prescribing practices.

Core Findings: Shining a Light on the Path from Prescription to Addiction

Published in the journal Surgery, the study highlights the persistent use of opioids by many patients following cardiothoracic surgeries, revealing a relationship between post-surgical care and opioid crisis management.

The authors conducted a comprehensive review of patient records from 2014 to 2016, which included provincial medical services, prescription claims, and medical charts to track opioid usage.

Here's what they found:

• 8.2% of the patients continued using opioids long after their surgery

• Factors that contributed to long-term usage included histories of substance and alcohol abuse

• Combining opioids with other non-opioid pain relief methods (called multimodal analgesia) can reduce the likelihood of long-term opioid use

“Opioid drugs have been a routine component of postoperative pain management for decades. However, North America is currently in the midst of an opioid crisis fueled, in part, by excessive opioid prescribing by surgeons.”

Why the Findings Matter: Rethinking Our Approach to Pain

Fentanyl — a synthetic opioid that is now a common street drug — is 50-100 times more potent than morphine, and has become a significant contributor to opioid-related deaths. Prescription opioids like OxyContin and Percocet, which are often used for pain management following common surgeries, are increasingly being linked to future use of illegal substances like fentanyl and heroin.

A 2018 study found that when young people received an opioid prescription following wisdom tooth extraction (a highly common procedure) they were more likely to be using opioids 3-12 months following the procedure.  

The McGill research adds welcomed nuance to these previous findings, supporting the need for new pain management protocols.

"Even opioids prescribed for low-pain, outpatient, or short-stay surgeries increase the risk of persistent opioid use, and over 60% of people receiving 90 days of continuous opioid therapy remain on opioids years later."

— Hah, et al.

Future in Focus: Retooling Pain Management

From robust pre-screening to more personalized pain management, there are several known strategies that can improve guidelines and practices:

• Enhanced Prescribing Guidelines

  • Tailored drug programs that combine opioids with other drug types can reduce the chances of persistent opioid use following surgery

  • Different types of surgery can carry different regimens, emphasizing non-opioid medications and techniques

• Prescription Monitoring Programs (PMPs)

  • PMPs programs can flag high-risk patients who receive opioid prescriptions post-surgery

  • Integrating regional and federal level tracking can monitor prescription patterns and ensure that high-risk patients are monitored more closely

• Provider Education and Training

  • Ongoing education, licensing, and certification for medical professionals can highlight the risks of opioid dependency and the benefits of multimodal pain management strategies.

• Public Health Campaigns

  • Because the public is less aware of surgery-related risk, informing people about risks and alternatives could shift patient expectations

• Research and Development Funding

  • Further research into effective pain management strategies and alternatives can support new guidelines and practices

• Cross-sector Collaboration

  • Engaging healthcare providers, insurers, patient advocacy groups, and pharmaceutical companies concurrently to build a concerted approach

As our over-reliance on opioids increases rates of dependency, overdose, and death across the country, the search for safer, effective pain management protocols grows more urgent.

How will we finally reduce our dependency on opioids? It will likely take more funding, more rigorous research into alternatives, and a monumental shift in practice.

---

🍁 Subscribe for weekly updates from Science Canada →