Persistent opioid use following a cardiac implantable electronic device (CIED) procedure is common, according to a study published in Circulation, which reports that 12% of patients receiving a CIED are consistently using pain medication in the months after the device has been implanted.
Using data from a US claims database of adult patients undergoing CIED procedures from 2004 to 2018, researchers from the Perelman School of Medicine at the University of Pennsylvania (Philadelphia, USA) found that of their sample of 143,400 patients, 15,316 patients filled an opioid prescription within two weeks of surgery.
Of those patients, persistent use—defined as filling another opioid prescription between one and six months after the procedure—occurred in 1,901 patients (who did not have a history of opioid use), or 12.4%, compared to 5.4% of patients without an initial prescription.
“Even a small number of oxycodones can start the addiction process,” said senior author David S Frankel, an associate professor of Cardiovascular Medicine and director of the Cardiac Electrophysiology Fellowship Program at the Perelman School of Medicine at the University of Pennsylvania. “The significance of this study is to make other electrophysiologists aware that even a low-risk procedure like a pacemaker or a defibrillator can lead to chronic opioid use and that physicians may want to be more conservative in prescribing opioids after surgery.”
As opioids include a variety of medications containing oral hydrocodone, oxycodone, hydromorphone, tramadol, codeine and other drug types, the researchers converted the initial post-procedure opioid script—the prescribed dose multiplied by the total number of pills—into oral morphine equivalents to have a standardised measurement. They found that patients who received an initial dose of postoperative opioids exceeding 135 oral morphine equivalents—or 18 tablets of five-milligram oxycodone—were at higher risk for persistent opioid use.
“We are still in the midst of a very lethal health crisis with opioid overdoses, and prescription opioids are often the initial exposure,” Frankel said. “Opioid dependence is not something that you as the provider can predict; it is better to assume that anyone could be susceptible.”