Tapering Acute Postoperative Opioids in Patients on Medication Assisted
Treatment for Opioid Use Disorder
Abstract
Aim: To investigate perioperative opioid usage in patients on methadone
or buprenorphine as medication assisted treatment for opioid use
disorder (MOUD) that attended a transitional pain clinic (Personalized
Pain Program, PPP). Methods: In this retrospective cohort study, data
was abstracted from the electronic medical record of adults on MOUD with
surgery and attendance at the PPP between 2017-2022. Daily non-MOUD
opioid use over 5 time-points was evaluated with regression models
controlling for differences in days since surgery. Time to complete
non-MOUD opioid taper at the last PPP visit was analyzed by accelerated
failure time and Kaplan-Meier models. Results: Fifty patients (28 on
methadone, 22 on buprenorphine) were included with median age of
44.3years, 54% male, 62% Caucasian, and 54% unemployed. Methadone
inpatient administration occurred in 92.8% but only 36.3% of
buprenorphine patients. Non-MOUD opioid use decreased over time
(β=-0.54, p<0.001) by a median of 90mg morphine equivalents
(MME) during PPP with 46% tapered off by the last visit. Older age,
employment status, duration in PPP, and extremity surgery were
associated with lower MME while mental health conditions, longer
hospital stay, and higher discharge opioid prescriptions were
unfavorable. The average time to non-MOUD opioid taper was 1.79x longer
in buprenorphine patients (p=0.026), 2.75x in males (p=0.023), 4.66x
with a mental health condition (p<0.001), 2.37x with chronic
pain (p=0.031), and 3.51x if non-MOUD opioids were prescribed
pre-admission, however, higher initial MOUD level decreased time to
taper (p=0.001). Conclusion: Postoperative opioid tapering utilizing a
transitional pain service is possible in patients on MOUD.