Perioperative Serum 25-Hydroxyvitamin D Levels as a Predictor of Postoperative Opioid Use and Opioid Use Disorder: a Coh
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Department of Population Medicine, Harvard Medical School, 401 Park Drive #401, Boston, MA, USA; 2Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Boston, MA, USA; 3Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
IMPORTANCE: Vitamin D deficiency is associated with chronic pain syndromes and higher opioid use among cancer patients, but its association with opioid use among opioid-naïve subjects following a major surgical procedure with acute pain has not been explored. OBJECTIVE: To determine the association between serum 25-hydroxyvitamin D (25(OH)D) levels, opioid use, and opioid use disorder. METHODS: We identified commercially insured subjects aged 18–64 years with available perioperative serum 25hydroxyvitamin D (25D) levels who underwent one of nine major surgical procedures in 2000–2014. Primary outcomes were dose and duration of opioid use measured using pharmacy claims. Secondary outcome was opioid use disorder captured using diagnosis codes. Multivariable negative binomial models with generalized estimating equations were performed examining the association between 25D levels and postoperative opioid use measures, adjusting for age, sex, race/ethnicity, Charlson score, education, income, latitude, and season of blood draw. Adjusted Cox regression was used to examine the association with opioid use disorder. RESULTS: Among 5446 subjects, serum 25(OH)D was sufficient (≥ 20 ng/mL) among 4349 (79.9%) subjects, whereas 837 (15.4%) had insufficient (12 to < 20 ng/mL) and 260 (4.8%) had deficient (< 12 ng/mL) levels. On multivariable analysis, as compared with subjects with sufficient 25(OH)D levels, subjects with deficient 25(OH)D levels had 1.7 more days (95% CI 0.76, 2.58) of opioid use per year and had 98.7 higher morphine milligram equivalent dose (95% CI 55.7, 141.8) per year. Among 11,713 study cohort, subjects with deficient 25(OH)D levels were more likely to be diagnosed with opioid use disorders (HR 2.41; 95% CI 1.05, 5.52). CONCLUSION: Patients undergoing common surgical procedures with deficient 25D levels are more likely to have higher opioid use and an increased risk of opioid use disorder compared to those with sufficient levels. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06001-y) contains supplementary material, which is available to authorized users. Received October 8, 2019 Accepted June 17, 2020
Serum 25D levels may serve as a biomarker to identify subjects at increased risk of opioid misuse. KEY WORDS: vitamin D; 25(OH)D; chronic opioid use; opioid use disorder; opioid-related disorders/epidemiology.
J Gen Intern Med DOI: 10.1007/s11606-020-06001-y © Society of General Internal Medicine 2020
INTRODUCTION
Harms associated with opioid use are a national crisis and have been declared by the US President as a “public health emergency.”1
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