The University of Michigan recently received a $3.3 million grant to launch a comprehensive data science project that aims to inform best practices on pre- and post-surgical care procedures for patients with opioid use disorder.
Opioid overdoses account for more than 200 deaths per day across the United States, making it the single deadliest drug epidemic in U.S. history, affecting a wide range of demographics.
With support from the National Institute on Drug Abuse, this five-year study will be the first project to examine the discontinuation of medications for opioid use disorder (MOUD) after surgery, and the first national study to document levels and drivers of MOUD post-surgery treatment retention.
Researchers from the U-M Opioid Research Institute will analyze several national claims databases across payer types, including Medicaid, Medicare and national commercial insurance covering 55 million Americans, with a special focus on care before, during and after surgery for non-elective and elective procedures.
“Due to the current lack of evidence on the impact of surgery on opioid addiction treatment retention, this study will address this important knowledge gap and provide a better understanding of patient outcomes,” said Thuy Nguyen, assistant professor of health management and policy in the School of Public Health, faculty affiliate of the Opioid Research Institute and the principal investigator of the grant.
Advocates of temporarily discontinuing buprenorphine or other MOUD for surgical patients believe the pause will prevent escalation in opioid prescribing and better surgical pain management, Nguyen said.
However, more recent practice guidelines on buprenorphine for surgical patients have conflicting recommendations, in part, because if buprenorphine is not continued, patients may be at high risk of relapse and overdose.
“Findings from this study will advance guidelines on treating pain after surgery for persons with opioid use disorder from expert opinion to evidence-based medicine, and reduce opioid-related morbidity and mortality following surgery,” said Mark Bicket, associate professor of anesthesiology in the Medical School, associate professor of health management and policy in SPH, faculty affiliate of the ORI, and the multiple principal investigator of the grant.
Although effective at preventing relapses and illicit opioid use, buprenorphine and other MOUD also may create challenges when traditional opioids are prescribed to treat acute pain because they both compete for the same opioid receptors. Preliminary research has found that this competition creates conflict and may impair the care of surgical patients taking these necessary medications for OUD.
“Results from this project will provide evidence to help develop best practices for patients living with opioid use disorder who undergo surgery or have other acute pain care,” said Amy Bohnert, professor of anesthesiology and psychiatry in the Medical School, associate professor of epidemiology in SPH, and co-director of the ORI.
“This analysis will allow for a better understanding of outcomes and for key stakeholder groups, including patients, surgeons, policymakers, payers and others to make more informed decisions about the use of MOUD during the perioperative period.”