Persistent Opioid Use in New Zealand: Insight From a Universal Health System

The routine prescription of opioids after surgery has contributed to persistent opioid use (POU) and its attendant association with morbidity and mortality. Given that different patient populations and cultures throughout the world adopt varying sensibilities regarding the appropriate use of opioids for post surgical pain, it is informative to assess the rate of POU across the globe. New Zealand has a single, universal health care system. All patients in both private and public funded hospitals are incorporated into health databases that can be analyzed to answer important clinical questions. Gong et al reviewed the surgical records of 260,726 patients presenting for surgery, excluding trauma. They observed that 1 in every 11 patients developed POU. Opioid prescription risk factors implicating increased risk of POU were: changing to different opioid(s) after discharge (aOR= 3.21; 95%CI 3.04-3.38), receiving multiple opioids on discharge (aOR= 1.37; 95% CI 1.29-1.45), and higher total oral morphine equivalents (> 400 milligrams) (aOR= 1.23; 95% CI 1.23-1.45). Other risk factors associated with increased risk of POU included: neurosurgery or cardiothoracic surgery, higher comorbidity burden, preoperative analgesic use, smoking, and hypnotic use. Conversely, patients who were co-prescribed non-opioid analgesics on discharge had lower odds of POU (aOR= 0.91; 95% CI 0.87-0.95). A visual summary of this article is presented in this infographic, though the reader is strongly encouraged to review the cited article for a more thorough understanding of the illustrated concepts. Further epidemiological research will help better characterize POU globally and regionally with potential modifiable areas to address POU.