Controlled Substance Use Highlighted For Mastectomy, Reconstruction Patients

Author: By Lynda Williams, Senior medwireNews Reporter 

medwireNews: Women who undergo mastectomy and reconstructive surgery are at risk of becoming persistent users of opioids and sedative–hypnotic agents, indicates research presented during the 2020 San Antonio Breast Cancer Symposium. 

Investigator Jacob Cogan, from Columbia University Medical Center in New York, USA, presented an analysis of data from the IBM Truven MarketScan database for 35,292 women who underwent the procedures between 2008 and 2017, 98% of whom had a breast cancer diagnosis. 

None of the patients included in the study had filled a prescription for a controlled opioid or sedative–hypnotic agent in the 31–365 days before surgery. 

In the perioperative period, defined as the 31 days before and 90 days after surgery, 13.1% of 25,270 women who had not previously used an opioid and 6.6% of 27,651 women who had not previously used a sedative–hypnotic agent became persistent users of these controlled substances, defined as filling at least one perioperative prescription plus two further postoperative prescriptions, 90–365 days after surgery. 

Overall, 61.8% of patients used opioids only during the perioperative period and 32.4% used sedative–hypnotic agents only in this time period, while 25.1% and 61.0% of patients did not use these agents, respectively. 

Women were significantly more likely to become persistent opioid users if they had Medicaid versus commercial or Medicare insurance (odds ratio [OR]=2.31), a breast cancer diagnosis (OR=1.44), received chemotherapy (OR=1.33), or were aged 50–64 years or up to 49 years (ORs=1.29 and 1.27 vs 65 years and older). 

And persistent use of sedative–hypnotic agents had similar risk factors, of which the strongest were receipt of chemotherapy (OR=2.24) and Medicaid insurance (OR=1.85). 

Women with two risk factors were 2.27 times more likely to become persistent opioid and 2.55 times more likely to become persistent sedative–hypnotic agent users than those without any factors, with the odds increasing to a respective 6.34 and 7.71 for women with five risk factors. 

“Particular attention should be paid to patients with mental health diagnoses and substance use diagnoses when managing pain, anxiety and sleep disorders”, suggested Jacob Cogan and co-workers, noting that these were also risk factors for chronic use of controlled substances. 

While acknowledging that follow-up was limited to 1 year, the presenter said he hoped that the study will highlight awareness of the risk of long-term use of controlled substances after surgery, and advised in a press release that “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.” 

Reference 

Abstract GS3-08. Cogan JC, Raghunathan RR, Beauchemin MP, et al. Persistent controlled substance use following mastectomy with reconstruction surgery. 2020 San Antonio Breast Cancer Symposium; 8–11 December.