Risk of chronic opioid use low after RP

Chronic opioid use is rare following radical prostatectomy (RP) in Europe. Slightly more than half of men undergoing RP in Sweden between 2007 and 2017 were found to have filled an opioid prescription, but the proportion who became chronic opioid users was less than 1%.

Using data from nationwide Swedish registries, Walter Cazzaniga, MD, and colleagues found that preoperative opioid use was the strongest predictor of chronic postoperative use following RP. They presented their findings at the 2019 AUA annual meeting in Chicago and also published research on this topic in the Journal of Urology (2020; 203:145-50).

“Additional study is warranted to optimize the use of opioid and minimize risk of chronic use, particularly for high-risk patients, in the continued efforts to combat the opioid epidemic,” concluded Dr. Cazzaniga, visiting researcher, department of surgical sciences, Uppsala University, Uppsala, Sweden.

Also see: Could mpMRI replace prostate Bx for surveillance protocols?

Previous data suggest that up to 7% of opioid-naïve patients who receive an opioid prescription after surgical procedures become chronic opioid users, he said. Among a random sample of 10% of patient records from a large U.S. commercial health plan, the probability of continued opioid use was 6.0% at 1 year and 2.9% at 3 years after an opioid prescription following a surgical procedure.

To examine the risk of chronic opioid use following RP, the investigators used data from the Prostate Cancer Data Base Sweden linked to the Prescribed Drug Register to assess opioid prescriptions for 25,703 men who underwent RP from 2007 to 2017. The median age at RP was 64 years. Most men had clinical stage T1c disease, and most were categorized as intermediate risk. Sixty percent of the men underwent robot-assisted RP, 36% had open RP, and 4% had laparoscopic surgery.

Next: At least 1 Rx filled by 64%At least 1 Rx filled by 64%

The authors examined opioid use 1 year prior to RP and 1 year following RP. At least one prescription for an opioid was filled by 16,368 (64%) of the men.

The proportion of men undergoing RP who received a prescription for an opioid increased from 40% in 2007 to 59% in 2017. The pattern of opioid prescription changed from a preponderance of prescriptions for strong opioids (eg, morphine, fentanyl, oxycodone, buprenorphine, hydromorphone) in 2007 to nearly all opioid prescriptions being weak opioids (eg, tramadol, dihydrocodeine, codeine) by 2017.

Baseline consumption of opioids prior to RP was related to other comorbidities, with 1.9% of men having filled an opioid prescription in the preoperative period. There was a strong peak in opioid use in the first 6 weeks after the procedure, to 59%, which decreased after 2 months to a level (2.3%) that was only slightly higher than that at baseline.

Read: Prostate ablation technique yields positive results at 1 year

“This is true for the overall opioids and also for the strong and weak opioids, with the biggest peak for the strong opioids,” said Dr. Cazzaniga.

On a multivariable model, the following factors predicted new chronic opioid users after RP: intermediate- (OR=3.30, p=.04) or high-risk cancer (OR=5.29, p=.005); regional (OR=5.67, p=.01) or distant metastases (OR=9.37, p=.004); a Charlson Comorbidity Index of 1 (OR=1.94, p=.0004), 2 (OR=2.51, p=.001) or 3+ (OR=3.30, p=.006); and being unmarried (OR=1.38, p=.05). Undergoing a robot-assisted RP was associated with a lower risk of conversion to chronic opioid use (OR=0.71, p=.02).

“Our results report the first nationwide investigation in Europe about the opioid issue,” Dr. Cazzaniga said. “Even if we cannot conclude anything on pain management strategies to avoid chronic opioid consumption, physicians and patients should be aware of our results in order to tailor the postoperative pain management strategy in order to minimize potential abuse.”