Une étude publiée dans le BMJ associe la durée, plutôt que le dosage, des prescriptions d'opioïdes postchirurgicales aux risques de surdose et de mésusage

 

Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study, Gabriel A. Brat et al, British Medical Journal, January 17, 2108 (BMJ 2018; 360:j5790)

Cette étude révèle que chaque renouvellement et chaque prolongation d’une semaine d’une prescription d’opioïde sont associés à une augmentation importante du mésusage chez des patients n’ayant pas de tolérance acquise aux opioïdes. Les données recueillies au cours de l’étude suggèrent que la durée de prescription est plus étroitement liée au mésusage en début de période post-chirurgicale que le dosage. Voici un extrait de l’article :

In this study, we quantified the strong association between short term postsurgical refills and misuse. A single refill increased the potential of misuse by more than 40%, and the duration of use appeared to be the most prominent predictor of misuse. Our findings are important as they offer a potential lever for intervention and behavior change after surgery. Given that surgical and non-surgical patients receive similar numbers of opioid refills, these findings have the potential to extend beyond surgery. Surgeons and non-surgeons are changing the characteristics of their opioid prescriptions, but rates of misuse continue to increase. Clinicians are trapped between guidelines that recommend shorter duration and lower dosing of opioid drugs and a subset of patients who request or require opioids beyond the initial prescription. With these seemingly conflicting forces at play, our analysis provides a broad evidentiary framework to inform clinician behavior and promote protocol development. Further research of this relation is needed to determine how initial treatment regimens can minimize misuse and addiction.

Pour consulter l’article : https://www.bmj.com/content/360/bmj.j5790