Over the past years, the recommendations on the appropriate use of opioids in pain management have evolved in response to the opioid epidemic and the specific needs of certain groups of patients. Despite the long-standing problems of pain management in cancer care and diagnosis, the trends in opioid consumption in this setting sometimes result in prolonged long-term opioid therapy (LTOT). Such practices increase the risk of adverse outcomes, including opioid use disorder, overdose, and other major complications such as suicide. Â
Even among patients with early-stage cancer or noncancer conditions, opioid use after surgery is common. Studies indicate that approximately 10 % of patients undergoing cancer surgery develop new long-term opioid use. Cancer survivors are particularly vulnerable to the risks of LTOT, especially those who face financial hardship, unemployment, multiple comorbidities, tobacco use, or who live in urban or less-educated communities. Polypharmacy is another issue: approximately one out of 10 survivors is prescribed both opioids and benzodiazepines one year after completing cancer therapy.Â
This study investigates the effects of opioid prescribing post-surgery among U.S. veterans. Particularly, it examines the incidence of the new persistent opioid use (NewPersOU) and concurrent opioid-benzodiazepine use (CoBenzOp) during the first year post-surgery in patients who had never used opioids. It also evaluates patient, clinical, and treatment factors associated with these outcomes.Â
A retrospective cohort study based on the Veterans Affairs Corporate Data Warehouse was conducted by the researchers. The sample consisted of U.S. veterans aged 21 years or older, diagnosed with stage 0-III cancer and opioid-naive between January 1, 2015, and December 31, 2016. Primary outcomes included (1) the days of concurrent opioid and benzodiazepine prescriptions during the 13 months of the post-treatment period and (2) incidence of new persistent opioid use. The main exposure variable was total morphine milligram equivalents (MMEs) prescribed from 30 days before surgery through 14 days after the surgery, stratified by cancer type.Â
 Among 9,213 veterans, 366 patients (4.0%) were coprescribed opioids and benzodiazepines, and 981 patients (10.6) developed new persistent opioid use. After adjusting for patient, clinical, and geographical characteristics, those in the highest quartile of opioid exposure had, on average, 1.0 additional days of concurrent opioid-benzodiazepine prescriptions compared to patients without exposure (95% CI, 0.3-1.7). The survival analysis suggested that veterans in the highest quartile of opioid use had 1.6 times the risk of developing new persistent opioid use compared to veterans with no exposure (95% CI, 1.3-1.9).Â
In summary, about one in 10 veterans who were opioid-naïve before early-stage cancer surgery developed new persistent opioid use. Also, one in 25 used both opioids and benzodiazepines within the first year of treatment. Risks were even higher among veterans with chronic pain, multiple comorbidities, lower socioeconomic status, or who received adjuvant chemotherapy. Although cancer-related pain management must be individualized, unnecessary and prolonged opioid use should be avoided to reduce long-term harm. As cancer increasingly becomes a chronic condition and survival improves, strategies such as preoperative planning and enhanced provider–patient education on opioid risks are essential for safe and effective pain management.
References: Schapira MM, Chhatre S, Dow PM, et al. The impact of opioid use associated with curative-intent cancer surgery on safe opioid prescribing practice among veterans: An observational study. Cancer. 2025;131(18):e70009. doi:10.1002/cncr.70009
