Are doctors still prescribing too many opioids?

A new study led by a McGill University scientist suggests opioid painkillers are not always beneficial — and sometimes harmful — as patients recover from minor surgery.

The research, published in The Lancet, examined the results of 47 randomized clinical trials in patients discharged after undergoing a minor or moderate procedure, ranging from molar extraction to foot surgery. 

Dr. Julio Fiore, an assistant professor at McGill who researches post-operative recovery, said his team found that prescribed opioids had no more of an impact on the pain experienced after minor surgery than over-the-counter painkillers. 

At the same time, the study found a significant increase in side effects, including nausea, vomiting and constipation. 

Fiore said the findings suggest avoiding prescribing opioid painkillers could in many cases improve a patients' recovery experience, while helping to mitigate the well-documented perils of opioid addiction.

"We really expect that these findings encourage changes in prescribing practices," Fiore said in an interview.

"After all, like the prescription of opioids, like after discharge, our research showed that it does not seem to be as beneficial for patients as previously believed."

Fiore said there is a need for more research involving the prescription of opioids after major surgeries to determine best practices. 

Of the studies examined, 30 involved minor procedures (most of which were dental) and 17 involved procedures of a more moderate nature on, for instance, a shoulder or foot.

Among the opioids most commonly prescribed by surgeons are oxycodone, hydromorphone, tramadol and codeine, according to the researchers. 

The prescription of opioid painkillers varies widely across countries, and studies suggest Canadian doctors still prescribe more opioids than their counterparts in Europe — but not as much as doctors in the United States.

One 2019 study examining post-operative prescriptions found that almost half of U.S. patients had received high-dose opioid prescriptions after certain surgeries, which was nearly double the rate of Canada and nine times the rate of Sweden.

Dr. David Juurlink, head of clinical pharmacology at Sunnybrook Health Sciences Centre in Toronto, who was not involved with the study, said many doctors and dentists in Canada still put opioid painkillers on a "pedestal."