Canadians are far more likely to fill a prescription for opioid painkillers following routine surgery than patients in Sweden, suggesting the powerful narcotics are still being handed out too liberally despite calls for change.
A new study published Wednesday in the journal JAMA Network Open found that about 79 per cent of Canadian patients and 76 per cent of U.S. counterparts filled an opioid prescription in the seven days following a routine surgical procedure, compared to just 11 per cent of patients in Sweden. The patients all underwent one of four minor procedures: laparoscopic surgery to remove the appendix or gallbladder, arthroscopic or keyhole surgery to remove the meniscus from the knee, and a surgery to remove a breast lump.
“We often think opioids are the best painkillers for acute pain,” said Karim Ladha, one of the study’s authors and an anesthesiologist at St. Michael’s Hospital in Toronto. “In other countries, they don’t even bother going there.”
Canada is in the midst of an opioid overdose crisis, with 12 people dying every day as a result of the drugs. Illicit fentanyl is to blame for the vast majority of the deaths. But prescription opioids still play a large role in the problem and put people at risk of addiction, dependence and misuse.
New national guidelines were published in 2017 to help clinicians navigate opioid prescribing for chronic pain patients, but there are no similar national guidelines for acute pain. Recently, research has pointed to the risks of prescribing opioids for acute pain and a growing number of experts are calling attention to the issue.
Dr. Ladha said his wife’s experience following a Caesarean section was one of the reasons he did the study. Despite not needing an opioid painkiller during her hospital stay, Dr. Ladha’s wife was discharged with a 30-day prescription for narcotic painkillers.
He said it’s time for patients and clinicians to shift their thinking about how pain is treated and managed. For too long, the objective seemed to be ensuring patients remained free of pain at all times, Dr. Ladha said, but that mindset exposes them to risks of opioid dependence and other problems.
“We need to set expectations regarding pain after surgery and we really need to prescribe in a way that’s tailored to what patients need,” he said.
Anita Srivastava, an assistant professor in the department of family and community medicine at the University of Toronto, echoed those comments, saying opioids shouldn’t be the default prescription, particularly in light of the risks they pose.
“I think that the idea that we just automatically get a prescription for pain or that there will be no pain after a procedure has to shift,” she said.
The study found patients in the United States were more likely to be given higher doses of opioids than those in Canada. But the study found Canadians were more likely than Americans to be prescribed codeine and tramadol. Some opioid addiction experts say those drugs are often wrongly perceived as safer opioids, which could explain why they are prescribed so frequently after minor surgery.
The study period in Canada took place between July, 2013, and March, 2016. While it’s possible prescribing rates have fallen since then, Dr. Srivastava said the trends are likely very similar today.
“My guess is there would still be a large gap between us and Sweden,” she said.
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Carly Weeks