To Örebro University

Opioid analgesics are highly effective in acute pain, but chronic opioid use can result in serious adverse consequences. Concerns about emerging opioid use after bariatric surgery have been raised. The aim of this thesis was to find out if opioid use is increasing after bariatric surgery in Sweden. Study I included patients operated with primary gastric bypass surgery. Chronic opioid use increased from 4.6% beforeto 5.5% after surgery and daily dose from 1.9 mg to 2.5 mg. No differencein opioid use between women and men was found. In study II we increased the follow-up period to 8 years and compared biannual prevalence of opioid use and daily dose in patients going through any bariatric surgery procedure with an obese control group going through a commercial intensive lifestyle treatment. In the surgical group, opioid use prevalence and dose increased more rapidly than in the intensive lifestyle group. Surgery patients were also found to have an increased risk of dying from opioid-related causes.

In study III we investigated if socioeconomic factors are associated with new chronic opioid use after gastric bypass surgery. We found that the risk of new chronic opioid use increase if you; are second generation immigrant, receive financial aid, are unemployed or divorced/widowed. Having a higher level of education and a higher disposable income reduced the risk of chronic opioid use in the study. In study IV we examined if having an opioid prescription dispensed at discharge was associated with chronic opioid use after gastric bypassor sleeve gastrectomy. We found that 32.3% of the patients had an opioid prescription dispensed at discharge, and that this was associated with an almost doubled risk of chronic opioid use three years after surgery.