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Opioids are effective medicines for severe pain following surgery, but prolonged use is associated with risks such as dependence and overdose. In his thesis, Claes Gedda at the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, investigated how common it is for patients in Sweden to continue using opioids after surgery, which patients are at higher risk, and whether usage following major surgery can be reduced.

The largest study included 1,245,211 adults who underwent surgery in Sweden between 2018 and 2022 and who had not collected opioids for most of the year prior to their operation. Of these, 35,132 people, or 2.82%, continued to collect opioids both during the first three months and during months four to six after surgery.

"This corresponds to around 7,000 patients per year in Sweden who collect opioids long after they should have recovered from surgery," says Gedda.

The risk was higher, for example, among older people and those with greater comorbidity, a recent cancer diagnosis, chronic pain, anxiety or depression, as well as alcohol or drug problems. Emergency surgery was also linked to a higher risk. Patients who collected opioids during the first week after surgery were more than twice as likely to still be collecting them several months later.

"Our results show that part of the risk can be identified even before surgery. At the same time, postoperative prescribing is a factor that the health care system can actually influence," says Gedda.

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