Thousands get hooked on opioids after plastic surgery

Thousands of plastic surgery patients get hooked on opioids after their operations, new research warns.

In a study of nearly 500,000 people who’d gone under the knife, 50,000 went on to use the highly-addictive painkillers for longer than needed.

The highest risk was among breast job and tummy tuck patients, likely because those operations can often be more invasive and painful than others.

As plastic surgery rates rocket, researchers warn these findings show a specific need for guidelines on opioid use before, during and after plastic surgery.

They say increased use of non-opioid alternatives, which are increasingly common in operating theaters, would lower the risk of later dependence.  

In a Stanford study of nearly 500,000 people who’d gone under the knife, 50,000 went on to use the highly-addictive painkillers for longer than needed

‘Given the elective nature of the majority of these procedures, the risk of opioid dependence is even less acceptable than in patients undergoing procedures to preserve life or mobility,’ the authors at Stanford University wrote in the paper, published today in the journal JAMA.  

Just shy of 18 million Americans underwent cosmetic procedures – both surgical and minimally invasive – in 2017, the latest year for which we have data. That figure has steadily climbed year-on-year – up from 5.5 million in 2000 – and is expected to do so again. 

A lot of that boost has come from minimally-invasive procedures like Botox. Surgery alone accounted for almost 1.8 million procedures in 2017. 

But surgeries are steadily climbing, too, with breast augmentations, tummy tucks and rhinoplasties (nose jobs) among the most popular.   

All surgical procedures involve painkillers, and the addiction crisis that exploded in the last decade forced all areas of the medical field to reassess how it treats patients. 

The new report by lead by Sam P Most, MD, a plastic and reconstructive surgery at Stanford Hospital and Clinics, looked at patients with an average age of 50 who had all undergone procedures.

They found that the patients most at-risk of opioid dependence or addiction are the ones whose operations involve opioids, which is common for most invasive procedures. 

But these days there are plenty of non-opioid alternatives, which, he suggests, could significantly lower the risk.

According to Dr Alan Matarasso, director of the American Society of Plastic Surgeons, there is a shift in that direction. 

The industry has been keenly following updates to federal guidelines when it comes to opioid prescribing and use during surgery, which has led to a 3 percent drop in prescription rates. 

‘There has been a profound shift of our use of opioid and understanding who’s at risk,’ Dr Matarasso told 

‘Those days [of freely using opioids] are over. We are much more aware of prescribing patterns and we are much more aware of alternative methods.

‘We have long-acting painkillers that would be injected direct into an area [rather than pumping the patient’s entire body with painkillers].’  

As for after surgery, Dr Matarasso says his clinic and most others ‘barely’ prescribe any addictive opioids.

But in some cases, he concedes, it’s unavoidable and the surgeon has to weigh up the risks, and counsel the patient.

The report found patients with anxiety, depression, substance abuse, and diagnosis of chronic pain had higher rates of persistent postoperative opioid use. 

Dr Most suggests surgeons conduct more extensive screening of patients’ mental health and explore non-opioid alternatives to use during the operation that will not raise the risk of addiction. 

‘This is particularly important given that 40 percent of all opioid-related deaths in the United States during 2016 involved the use of a prescription opioid,’ Dr Most and colleagues wrote.

‘In addition, past-year misuse of prescription opioids has been found to be a strong predictor of heroin abuse, with many heroin users reportedly transitioning from prescription opioids to heroin because of its wide availability and reduced cost when compared with prescription opioids.’