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Mastectomy may raise risk of persistent use of opioids, sedative-hypnotics

2020 San Antonio Breast Cancer Symposium
Reuters Health - 11/12/2020 - Women with breast cancer who undergo mastectomy and reconstructive surgery may be at risk of becoming persistent users of opioids and sedative-hypnotic drugs, according to a new study.

"I hope that our study can increase awareness that these are addictive medications, and a brief exposure for surgery-related pain or anxiety can lead to long-term use," Dr. Jacob Cogan said in a news release from the virtual 2020 San Antonio Breast Cancer Symposium where he presented the data.

"Both patients and providers should be aware of this issue, and of the risk factors that elevate an individual patient's risk," added Dr. Cogan, a hematology/oncology fellow at NewYork-Presbyterian/Columbia University Irving Medical Center in New York.

Using a healthcare claims database, the researchers studied women who underwent mastectomy and reconstruction between 2008 and 2017. They identified prescriptions for opioids and sedative-hypnotics during the preoperative period (365 days to 31 days prior to surgery), the perioperative period (31 days prior to 90 days after their surgery), and the postoperative period (90 days to 365 days after surgery).

The cohort included 25,270 women who were not prior users of opioids and 27,651 who were not prior users of sedative-hypnotics. Women who had no use in the preoperative period but filled at least one prescription in the perioperative period and at least two prescriptions in the postoperative period were considered new chronic users.

Dr. Cogan reported that 13.1% of opioid-naive patients became new persistent opioid users after mastectomy and reconstruction, while 6.6% of sedative-hypnotic-naive patients became new persistent sedative-hypnotic users.

Predictors of new persistent opioid or sedative-hypnotic use included younger age, Medicaid insurance and chemotherapy treatment. The odds of becoming a persistent user increased with the number of risk factors.

"Patients should be vigilant about taking these medications only when necessary, and they should work closely with their prescribing provider to attempt to minimize risk of dependence," Dr. Cogan said in the release.

Weighing in on the results for Reuters Health, Dr. Sarah P. Cate, assistant professor of breast surgery at Icahn School of Medicine at Mount Sinai, in New York City, said, "In an era where opioid overuse is an epidemic, this study brings to light a very important issue. Current guidelines suggest patients do not need opioid medications for breast conservation surgery or lumpectomy. Rather, we use Tylenol, NSAIDs such as Toradol, and other non-narcotic medications to control pain postoperatively."

"Mastectomies with reconstruction are known to cause significantly more pain. Therefore, it is not surprising that these patients took more narcotics. However, we cannot assume patients took the full prescriptions from this study or exactly how much narcotic medications patients actually took from the way the study was conducted," said Dr. Cate, who was not involved in the study.

"This study highlights the need for investigation of non-narcotic medications and nerve blocks. For example, at my institution, we are using local nerve blocks with long acting injectable pain medicine that greatly decreases narcotic usage. This has greatly decreased hospital stays and narcotic usage," she added.

SOURCE: https://bit.ly/3maMzLz 2020 San Antonio Breast Cancer Symposium, presented December 9, 2020.

By Megan Brooks

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