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Published on December 16, 2020
Opioid Prescription After Mastectomy and Reconstruction Poses Risk for Patients
Women who undergo a mastectomy and reconstruction as a part of breast cancer treatment may be at an increased risk for dependence on opioids and sedative-hypnotic drugs (benzodiazepines), according to data presented at the 2020 San Antonio Breast Cancer Symposium. Sedative-hypnotics, such as clonazepam, temazepam and midazolam, are frequently prescribed to patients with cancer around the time of surgery to combat anxiety or insomnia.
Researchers evaluated the health care claims of women who underwent mastectomy and reconstruction between 2008 and 2017. They identified prescriptions for opioids and sedative-hypnotics during three time periods: the preoperative period (365 days to 31 days prior to surgery); the perioperative period (31 days prior to and 90 days after surgery); and the postoperative period (90 days to 365 days after surgery).
The team identified 25,270 women who were not prior users of opioids, and 27,651 who were not prior users of sedative-hypnotics. Patients were considered chronic users if they filled at least one prescription in the perioperative period and at least two prescriptions in the postoperative period.
Results showed that 13.1% of opioid-naive patients become new persistent opioid users after a mastectomy and reconstruction; 6.6% of sedative-hypnotic-naive patients become new persistent sedative-hypnotic users. When removing “non-user” patients from these groups (i.e., those who did not receive or fill a perioperative controlled substance prescription), the rates rose to 17.5% and 17%, respectively.
“It has become clear that short-term exposure to opioids for any reason can lead to long-term dependence, given the highly addictive potential of these agents,” explained the study’s lead author, Dr. Jacob Cogan, a fellow in hematology/oncology at New York-Presbyterian/Columbia University Irving Medical Center. “Many patients receive this initial exposure around the time of surgery, and patients with cancer are at particularly high risk of becoming dependent on opioids postoperatively.”
The study also found that the chance of becoming a persistent user of both types of controlled substances was significantly higher among women under age 60, those with a breast cancer diagnosis (versus those who had prophylactic surgery) and those treated with chemotherapy. As the number of risk factors increased, the risk of becoming a persistent user also increased.
Dr. Cogan cautioned that the results do not suggest that women with breast cancer should avoid opioids and sedative-hypnotic drugs. “Rather, patients should be vigilant about taking these medications only when necessary, and they should work closely with the prescribing provider to attempt to minimize risk of dependence,” he said.
The study was funded by the Breast Cancer Research Foundation and the National Institutes of Health. Read the full press release and abstract here.
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