Patients turn to opioids to kill the pain as they wait for NHS surgery
Opioid use among patients waiting for hip and knee surgery was 40 per cent higher during the past year compared to pre-pandemic levels, according to new research.
The drugs, such as morphine and tramadol, are often used as a last resort in pain management in osteoarthritis. However, researchers said there was growing evidence it could be of limited benefit and even a long-term detriment to health, especially in older adults.
According to the University of Aberdeen study, published in the BMJ Quality & Safety, half of patients who were on the waiting list during the pandemic were on weak opioids when they were followed-up pre-surgery.
This compares to 36.4 per cent of those who were added to the waiting list pre-pandemic, a relative increase of around 40 per cent.
The surge in opioid use for pre-operative pain was associated with the waiting time for surgery which was an average of 90 days longer during the pandemic as hospitals shifted to focus on providing acute care.
Although the study used data from patients in the North East of Scotland, latest NHS England figures also show long waiting times for the surgery.
As of July 2021, 681,190 people were waiting for trauma and orthopaedic surgery, which includes hip and knee, up 30 per cent from Jan 2020.
The authors warn “prolonged” waiting time for surgery should be avoided during the Covid recovery to prevent “more widespread opioid use”.
Long-term opioid use before surgery has also been associated with increased risk of complications related to the operation, poorer outcomes, and ongoing opioid dependence.
Luke Farrow, a clinical research fellow at the University of Aberdeen’s Institute of Applied Health Sciences, who led the research, said alternative ways of managing severe arthritis pain must be found “urgently” for those waiting for this kind of surgery.
He said: “Our work provides evidence of potential for an emerging opioid problem associated with the influence of Covid-19 on elective orthopaedic services.
“With continued delays in the provision of timely total hip and knee arthroplasty expected for some time due to the considerable backlog of patients awaiting surgery, patients will need to seek alternative treatment options to manage their symptoms.
“We would advocate that healthcare professionals and patients avoid the use of opioid medication if at all possible due to the known lack of effect in this setting and potential for harm.
“We urgently need to find better alternative methods for managing severe arthritis pain for those awaiting this type of surgery and work to recover the backlog of associated operative cancellations during Covid-19 to prevent more widespread opioid use.”
The study looked at data collected from 452 NHS patients from the North East of Scotland who were on the waiting list for hip and knee replacement surgery and compared the numbers of patients who had been prescribed opioids with those who had surgery before the pandemic.
