Preventing opioid prescription after surgery: Moving towards opioid-free analgesia

Current Projects

1. Opioid Versus Opioid-free Analgesia After Surgical Discharge: A Systematic Review and Meta-analysis

Canada is facing an unprecedented epidemic of opioid addiction and overdose. In 2018, 4,623 people died in Canada due to opioid-related overdoses. Prescription of opioids postoperatively may be an important cause of the opioid crisis. Thus, using opioid-free analgesia after surgery might be the answer. However, this approach must be informed by robust systematic reviews and meta-analyses, which are currently absent from the literature. The objective of this project is to summarize the evidence regarding the comparative-effectiveness of opioid versus opioid-free analgesia after surgical discharge. We anticipate that our results will contribute important new evidence to guide clinical decision-making regarding postoperative analgesia and inform policies aimed to optimize opioid prescriptions after surgery.

2. Opioid-free analgesia after outpatient general surgery: A pilot randomized controlled trial

Overprescription of opioids after surgery has been implicated as a driving force behind the growing number of overdoses and deaths in Canada. Postoperative opioid overprescription is an urgent element of the Canadian opioid crisis given how commonly it may contribute to misuse, diversion, addiction and death. This project aims to estimate the extent to which opioid and non-opioid analgesia regimens impact postoperative outcomes after outpatient general surgery. Due to the complexities inherent in well-designed randomized controlled trials (RCT), we are conducting a pilot study to optimize the parameters required for a full-scale trial. Eligible patients are recruited at two sites of the McGill University Health Centre (Montreal General Hospital and Royal Victoria Hospital).

3. Evaluation of Opioid Prescription and Consumption After Hospital Discharge Following Colorectal Surgery: A Prospective Cohort Study

A recent study looking at postoperative opioid prescriptions among 3,6000 opioid-naive patients following various surgical procedures found that patients undergoing colorectal surgery had the highest incidence of persistent opioid use (10%). Thus, optimizing opioid prescribing for this patient population is an important target for quality of care improvement. However, to do so, it's important to understand how opioids are being prescribed by clinicians, and subsequently used by the patients.
The goal of this prospective cohort study is to determine the extent to which clinicians prescribe opioids for colorectal surgery patients, and to determine how the patients are using and disposing of their prescriptions. Furthermore, we hope to identify characteristics that may predict persistent opioid consumption following discharge. Eligible patient's will be recruited from two sites, the Montreal General Hospital and the Jewish General Hospital, and will be followed for up to 180 days following their discharge from the hospital.

4. General Surgeons' Attitudes and Beliefs Regarding Postoperative Opioid Prescribing

Surgeons are the second largest subgroup of physicians involved in opioid prescribing, making them important contributors to the opioid crisis. Surgical patients are frequently prescribed opioids to take at home after they are discharged from the hospital. There is currently limited research available to inform optimal postoperative opioid prescribing, which leaves the decision to prescribe opioids after surgery dependent upon surgeons preferences and healthcare culture. Therefore, there is an urgent need to understand surgeons’ decision-making process when prescribing opioids after surgery and to identify the factors that influence postoperative opioid prescribing. We are conducting interviews with general surgeons to understand their knowledge, attitudes and beliefs towards opioid prescribing. This will help to develop strategies to reduce postoperative opioid overperscribing and mitigate the negative downstream effects of postoperative opioid overprescription.

Publications

(*Denotes role as supervisor of the first author)
  1. El-Kefraoui C*, Olleik G, Chay MA, Kouyoumdjian A, Nguyen-Powanda P, Rajabiyazdi F, Do U, Derksen A, Landry T, Amar-Zifkin A, Agnihotram R, Martel M, Baldini G, Feldman LS, Fiore JF Jr. Opioid versus opioid-free analgesia after surgical discharge: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10: e035443. DOI

  2. Fiore JF Jr, Olleik G, El-Kefraoui C, Verdolin B, Kouyoumdjian A, Alldrit A, Figueiredo AG, Valanci S, Marquez-GdeV JA, Schulz M, Moldoveanu D, Nguyen-Powanda P, Best G, Banks A, Landry T, Pecorelli N, Baldini G, Feldman LS. Preventing opioid prescription after major surgery: A scoping literature review on opioid-free postoperative analgesia. Br J Anaesth 2019; 123 (5), 627-636. DOI