• Stefan Wallén, Gustaf Bruze, Johan Ottosson, Claude Marcus, Johan Sundström, Eva Szabo, Torsten Olbers, Maria Palmetun-Ekbäck, Ingmar Näslund, and Martin Neovius.
• Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
• Ann. Surg. 2023 Mar 1; 277 (3): e552e560e552-e560.

ObjectiveTo compare opioid use in patients with obesity treated with bariatric surgery versus adults with obesity who underwent intensive lifestyle modification.Summary Of Background DataPrevious studies of opioid use after bariatric surgery have been limited by small sample sizes, short follow-up, and lack of control groups.MethodsNationwide matched cohort study including individuals from the Scandinavian Obesity Surgery Registry and the Itrim health database with individuals undergoing structured intensive lifestyle modification, between August 1, 2007 and September 30, 2015. Participants were matched on Body Mass Index, age, sex, education, previous opioid use, diabetes, cardiovascular disease, and psychiatric status (n = 30,359:21,356). Dispensed opioids were retrieved from the Swedish Prescribed Drug Register from 2 years before to up to 8 years after intervention.ResultsDuring the 2-year period before treatment, prevalence of individuals receiving ≥1 opioid prescription was identical in the surgery and lifestyle group. At 3 years, the prevalence of opioid prescriptions was 14.7% versus 8.9% in the surgery and lifestyle groups (mean difference 5.9%, 95% confidence interval 5.3-6.4) and at 8 years 16.9% versus 9.0% (7.9%, 6.8-9.0). The difference in mean daily dose also increased over time and was 3.55 mg in the surgery group versus 1.17 mg in the lifestyle group at 8 years (mean difference [adjusted for baseline dose] 2.30 mg, 95% confidence interval 1.61-2.98).ConclusionsBariatric surgery was associated with a higher proportion of opioid users and larger total opioid dose, compared to actively treated obese individuals. These trends were especially evident in patients who received additional surgery during follow-up.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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