Persistent Opioid Use After CIED Procedures

Quick Takes

  • Persistent opioid use occurs in about 12% of patients who undergo cardiac implantable electronic device procedures and fill an opioid prescription after surgery.
  • Patients prescribed >135 mg of oral morphine equivalents had a significantly increased risk of persistent opioid use.

Study Questions:

What is the incidence of persistent opioid use (POU) among opioid-naïve patients after cardiac implantable electronic device (CIED) procedures?

Methods:

This was a retrospective look at a national administrative claims database from 2004–2018 of opioid-naïve patients undergoing CIED procedures. POU was defined by filling an additional opioid prescription >30 days after the CIED procedure.

Results:

From among 143,400 patients who met the study criteria: 15,316 (11%) filled an opioid prescription after CIED surgery. Among these patients, POU occurred in 1,901 (12.4%) patients 1–6 months after surgery. The likelihood of developing POU was increased for patients who had a history of drug abuse, preoperative muscle relaxant or benzodiazepine use, or opioid use in the preceding 5 years. POU rate was not different whether the CIED was transvenous or totally subcutaneous (12% vs. 11%). Patients prescribed >135 mg of oral morphine equivalents had a significantly increased risk of persistent opioid use.

Conclusions:

About one out of eight opioid-naïve patients who received postoperative opioids continued to use them after 1-6 months after CIED surgery. Higher initially prescribed oral morphine equivalent doses were associated with developing persistent opioid use.

Perspective:

Opioid use in the United States has reached staggering proportions and remains a major public health crisis. Public interest has focused mainly on the manufacturers of opioids, their distributors, and retail pharmacies, likely due to their ability to pay large damages. By and large, physicians have not been subjected to the same scrutiny. The present manuscript reveals that each of us may play a role in fueling the epidemic or helping to abate it. Patients with prior history of drug abuse, perioperative use of muscle relaxants or benzodiazepines, and opioid use in the preceding 5 years are at higher risk of persistent opioid use. A takeaway from this manuscript is that providers should avoid prescribing >135 mg of oral morphine equivalents or 18 tablets of oxycodone 5 mg.

Keywords: Arrhythmias, Cardiac, Analgesics, Opioid, Benzodiazepines, Defibrillators, Implantable, Heart Failure, Morphine, Morphine Dependence, Opioid-Related Disorders, Oxycodone, Pacemaker, Artificial, Pain, Postoperative, Public Health, Risk, Secondary Prevention


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