New persistent opioid use after surgery and traumatic injury: a narrative review of global rates, risk factors, and healthcare interventions.

Up to one-third of patients are discharged with opioids after surgery, and up to one-half after traumatic injury, with usage typically intended for the short term. Evidence on persistent opioid use predominantly originates from North America, particularly the USA, and focuses on the elective surgical population. Definitions of new persistent opioid use vary widely, particularly in how opioid-naïve patients are classified and continued use is measured. The reported incidence of new persistent opioid use after surgery and trauma ranges from <1% to 41%, depending on the population, setting, and definition used. Although patient characteristics and factors related to surgery and trauma care are key risk factors, many of which are not readily modifiable, opioid prescribing practices represent a modifiable and actionable target for intervention. Understanding these risks can assist healthcare providers in implementing alternative management strategies to promote judicious opioid prescribing and reduce persistent opioid use. High-income countries with substantial opioid-related harms have implemented various strategies, ranging from national to hospital-level initiatives, to reduce prescribing and limit opioid exposure after hospital discharge. A priority is the development and adoption of standardised definitions, which consider the various opioid medications, incorporate different data sources, and clearly define thresholds for duration and quantity of use. Further research on new persistent opioid use in more regions, after trauma, targeted interventions, and their impact on patient-centred outcomes is needed.