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New and persistent controlled substance use among patients undergoing mastectomy and reconstructive surgery

Abstract

Purpose

Prolonged use of controlled substances can place patients at increased risk of dependence and complications. Women who have mastectomy and reconstructive surgery (M + R) may be vulnerable to becoming new persistent users (NPUs) of opioid and sedative-hypnotic medications.

Methods

Using the MarketScan health-care claims database, we identified opioid- and sedative-hypnotic-naïve women who had M + R from 2008 to 2017. Women who filled ≥ 1 peri-operative prescription and ≥ 2 post-operative prescriptions within one year after surgery were classified as NPUs. Univariate and multivariable logistic regression analyses were used to estimate rates of new persistent use and predictive factors. Risk summary scores were created based on the sum of associated factors.

Results

We evaluated 23,025 opioid-naïve women and 25,046 sedative-hypnotic-naïve women. We found that 17,174 opioid-naïve women filled a peri-operative opioid prescription, and of those, 2962 (17.2%) became opioid NPUs post-operatively. Additionally, 9426 sedative-hypnotic-naïve women filled a peri-operative sedative-hypnotic prescription, and of those, 1612 (17.1%) became sedative-hypnotic NPUs. Development of new persistent sedative-hypnotic use was associated with age ≤ 49 [OR 1.77 (95% CI 1.40–2.24)] and age 50–64 [1.60 (1.27–2.03)] compared to age ≥ 65; Medicaid insurance [2.34 (1.40–3.90)]; southern residence [1.42 (1.22–1.64)]; breast cancer diagnosis [2.24 (1.28–3.91)]; and chemotherapy [2.17 (1.94–2.42)]. Risk of NPU increased with higher risk score. Women with ≥ 3 of these risk factors were three times more likely to become sedative-hypnotic NPUs than patients with 0 or 1 factors [2.94 (2.51–3.43)]. Comparable findings were seen regarding new persistent opioid use.

Conclusion

Women who have M + R are at risk of developing both new persistent opioid and new persistent sedative-hypnotic use. A patient’s risk of becoming an NPU increases as their number of risk factors increases. Non-pharmacologic strategies are needed to manage pain and anxiety following cancer-related surgery.

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Data availability

The data that support the findings of this study are available from IBM MarketScan, but restrictions apply to the availability of these date, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of IBM MarketScan.

Code availability

The codes utilized during the current study are available from the corresponding author on reasonable request.

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Funding

This research was partially funded by the Breast Cancer Research Foundation (DLH) and the American Cancer Society (DLH). Support for data acquisition provided by the Herbert Irving Comprehensive Cancer Center (P30CA013696).

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JC, RR, and DH. The first draft of the manuscript was written by JC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Dawn L. Hershman.

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Cogan, J.C., Raghunathan, R.R., Beauchemin, M.P. et al. New and persistent controlled substance use among patients undergoing mastectomy and reconstructive surgery. Breast Cancer Res Treat 189, 445–454 (2021). https://doi.org/10.1007/s10549-021-06275-8

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  • DOI: https://doi.org/10.1007/s10549-021-06275-8

Keywords

  • Mastectomy
  • Reconstruction
  • Opioid
  • Benzodiazepine
  • Breast Cancer