One in five patients is prescribed opioids after having a pacemaker or similar device implanted, according to a large U.S. study conducted at the Mayo Clinic.
Eighty percent of patients who were prescribed opioids had never taken them before. Investigators stressed the importance of improving postoperative pain management following cardiac device procedures to reduce the use of prescription opioids.
They performed a retrospective cohort study of all patients undergoing device procedures, including implantation of pacemakers, cardioverter defibrillators, generator changes, and lead extractions at the Mayo Clinic Enterprise Heart Rhythm Practice.
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The study included patients at the three academic campuses in Rochester, Minnesota; Phoenix, Arizona; and Jacksonville, Florida. More than 16,500 adult patients who underwent CIED procedures and were discharged between January 1, 2010 and March 30, 2018 were included.
WHAT'S THE IMPACT
Prescription opioids are a major contributor to the opioid epidemic in the U.S. and are linked to prescription opioid abuse, addiction and deaths due to overdose. More people now die due to prescription opioid overdose than from cocaine and heroin.
The procedures examined by Mayo were categorized into new implant, generator change, device upgrade, lead revision or replacement, and subcutaneous implantable cardiac defibrillator (S-ICD) procedures. The investigators assessed how frequently opioids were prescribed after the procedure, and how frequently patients who were prescribed opioids continued to refill their opioid prescriptions.
Opioids were prescribed to about 20% of the patients, of whom 80% were "opioid naïve" -- in other words, they had never taken opioids before. Among the opioid naïve patients who received opioids, more than 9% subsequently refilled their prescription. Close to 40% of these patients received more than 200 oral morphine equivalents on prescription.
The investigators concluded that several factors influence the decision to prescribe opioids, such as the healthcare provider's pain management training and prior experiences; patients' expectations of pain control; underlying comorbidities; and personal sensitivity to pain.
THE LARGER TREND
Nearly three quarters of primary care physicians worry that chronic pain patients will turn to illicit drugs if they do not have access to prescription opioids, according to a recent Health Trends report from Quest Diagnostics. Seventy percent of primary care physicians wish they had more training on how to taper their patients off opioids.
Physicians may be overconfident in their ability to recognize prescription drug misuse. Fifty-one percent of patient test results highlighted in the report showed misuse of a controlled medication or other drugs in 2018, a rate that is virtually unchanged from a misuse rate of 52% in 2017 and 2016. Yet, 72% of physicians trust their patients to take their controlled substances as prescribed.