Increase in opioid use for pain relief during pandemic, study finds

By Lucinda Cameron, PA Scotland & Alan Johnson

A study conducted by the University of Aberdeen has found that the numbers of patients using opioids while waiting for surgery increased by 40% compared to pre-pandemic levels.

The surge in usage for pre-operative pain was associated with the waiting time for surgery, which was an average of 90 days longer during the pandemic as hospitals shifted to focus on providing acute care.

Opioids such as morphine and tramadol are often used as a last resort in pain management in osteoarthritis. Researchers have found, however, that there is growing evidence it can be of limited benefit and even prove detrimental to long-term health, especially in older adults.

Long-term opioid use prior to surgery has been linked to an increased risk of complications related to the operations, poorer outcomes, and ongoing opioid dependence.

Luke Farrow, Clinical Research Fellow at the University of Aberdeen’s Institute of Applied Health Sciences, who led the research, said alternative ways of managing severe arthritis pain must be found "urgently" for those waiting for this kind of surgery.

"Our work provides evidence of potential for an emerging opioid problem associated with the influence of Covid-19 on elective orthopaedic services," he said.

"With continued delays in the provision of timely total hip and knee arthroplasty expected for some time due to the considerable backlog of patients awaiting surgery, patients will need to seek alternative treatment options to manage their symptoms.

"We would advocate that healthcare professionals and patients avoid the use of opioid medication if at all possible due to the known lack of effect in this setting and potential for harm.

“We urgently need to find better alternative methods for managing severe arthritis pain for those awaiting this type of surgery and work to recover the backlog of associated operative cancellations during Covid-19 to prevent to prevent more widespread opioid use."

The study looked at data collected from 452 NHS patients from the north east of Scotland who were on the waiting list for hip and knee replacement surgery and compared the numbers of patients who had been prescribed opioids with those who had surgery before the pandemic.

There has been widespread postponements of elective orthopaedic surgeries since the pandemic began, which was supported by the research that showed patients awaiting the most common procedures in hip and knee replacements were disproportionally affected.

Mr Farrow added: "Whilst these changes have served to flatten the curve and reduce some of the harm associated with Covid-19 infection, there has undoubtedly been an impact on patients whose elective procedures were postponed.

"Covid-19 has had a significant detrimental effect on access to hip and knee surgery, and work by others has suggested this has been associated with worsening pain and quality of life for patients."

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