Prolonged use of opioids after surgery

In a linked paper (doi:10.1136/bmj.g1251), Clarke and colleagues present the results of a large retrospective cohort study conducted in Canada in 39 140 patients aged 66 or more who underwent major elective surgery and had never taken opioids before the procedure.1 Nearly half of the patients were discharged from hospital with an opioid prescription, illustrating that anaesthetists and surgeons no longer hesitate to use major analgesics beyond the immediate postoperative period. Although this trend has a positive effect on patient comfort and rehabilitation, concern has been raised by another important result from this study—that 3.1% of the patients were still taking opioids more than 90 days after surgery. Similarly, a 7.7% rate of opioid prescription has been reported at one year after low risk day surgery,2 and a follow-up study recently showed that 15% of women started or increased their purchase of analgesics after hysterectomy for benign disease.3 The medical profession therefore needs to ask whether long term opioid use is a real …