Chronic Opioid Use May Increase After Bariatric Surgery: Study

Chronic users of powerful opioid painkillers, such as OxyContin and Morphine, may see their use of the medications increase following bariatric weight loss surgery.   

In a study published this week in the Journal of the American Medical Association (JAMA), researchers from Kaiser Permanente found that patients who regularly use prescription opioids often increase use in the years after the weight loss surgeries, which the scientists say suggests doctors are struggling with pain management for bariatric patients.

Only about 8% of patients who undergo bariatric surgery are chronic opioid users before the surgery, the researchers found. However, of those users, more than 77% continued to use opioid painkillers chronically in the year following surgery, with many patients using more of the prescription painkillers after surgery than they were before undergoing the weight-loss procedure.

According to the findings, some patients already chronically using opioids increased their use 13% in the first year after their surgery. Opioid use also increased as much as 18% within three years following bariatric surgery.

Marsha A. Raebel, Pharm.D, and a team of researchers from Kaiser Permanente in Denver reviewed the medical records of nearly 12,000 patients over the age of 21 who underwent bariatric surgery from 2005 through 2009. Patients were evaluated one year prior to surgery and one year following surgery.

“Obese patients are often more sensitive to pain and tend to be prescribed increasing opioid doses to manage that pain,” said Raebel.

In the year prior to surgery, 56% of patients reported not using opioid painkillers at all. Comparatively, 36% reported some use and 8% reported using painkillers chronically.

Researchers defined chronic use as having 10 or more prescriptions over a 90-day period or at least a 120-day total supply of medication sometime in the year before surgery. Some use was defined as one to nine prescriptions over 90-days or less than a 120-day supply in the year before surgery.

The findings of the study also suggested that neither depression nor chronic pain diagnoses prior to surgery influenced preoperative or postoperative chronic opioid use.

Bariatric surgeries include any surgery conducted to accomplish extreme weight loss measures, including various types of gastric bypass surgeries and duodenal surgery.

Controversial Side Effects of Bariatric Surgery

Bariatric surgery can result in improvements in weight, and as a result improvements in osteoarthritis associated with knee pain and function and decreased back pain. However, some studies have shown long-term use of opioids can lead to severe health issues, including increased erectile dysfunction in men, addiction, and fatal overdose.

However, this study is not the first to raise questions about the links between bariatric surgery and substance abuse.

A study published in JAMA in 2012 found a 10% increased risk of alcohol abuse among patients who received bariatric surgery. A similar study published in the Archives of Surgery also found a link between bariatric surgery and an increased risk for substance abuse and alcohol addiction. Researchers found a 50% increase in the frequency of drug use, alcohol use, or cigarette smoking two years after the procedure.

Patients who consumed alcohol prior to the surgery consumed even more postoperatively. While one in 25 patients used recreational drugs before surgery; one in eight participated in drug use within two years following surgery.