What is the background to this study?

Opioid drugs are commonly prescribed for pain relief, particularly following surgery. There have, however, recently been concerns raised, particularly from North America, of the harmful side-effects of these drugs when taken for long periods of time. In the USA particularly opioid drugs prescribed after surgery have been linked with the so-called ‘opioid epidemic’. In spite of this, there currently exists little evidence of the extent of overprescribing these drugs in Europe.

What did we want to find out?

Although there is a growing body of evidence in the USA and Canada of the harmful implications of taking opioids long-term, there was no good evidence of these effects in Europe. We wanted therefore to try and fill this gap, to see if these harms were also in evidence across European populations.

What did we do?

We undertook a systematic review of the current evidence in the existing literature. This consisted of searching several public databases of academic articles, looking for all reports of how many adults were still taking opioid medications several months after surgery. We were looking for studies which described opioid use by adults only (aged 18 and over) at least three months following surgery. This search was conducted in 2020, and we looked for all articles available that discussed this issue in a European context, regardless of the date they were first published.

What did we find?

We found 1307 studies in total meeting our criteria, and after excluding for ineligible and duplicate studies 12 were included in our final review. We looked at the rate of opioid use after 3 and 6 months in these studies and categorised these by the type of surgery involved. In all the included studies the proportion of opioid users varied significantly from as low as 2% up to 41% at 3 months after surgery. The level of evidence also varied from high to very low. It was also not possible to describe particular national trends, nor trends depending on the type of surgery involved within this review.

Why is this important?

Our intention in conducting this study was to provide an evidence base that could better inform those prescribing opioids in Europe as to the long term effects of taking these drugs. While anecdotally it could be assumed that the effects might be similar in Europe as North America, we wanted to study this to add more certainty to the clinical evidence base and decision making when prescribing opioids. However, due to the wide ranges observed in this particular study it was not possible to confirm nor deny any possible public health problem linked to the persistent use of opioid drugs in Europe. The results show that further research is required in this matter.

Who authored this study?

This study was authored by Professor Patrice Forget, who is a Professor of Anaesthesia at the Epidemiology Group, and Taalke Sitter, who is a Public Health student.

Who funded this work?

This study was performed in the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen and not externally funded.

Where can I find out more?

You can read the full article here.