Perioperative Serum 25-Hydroxyvitamin D Levels as a Predictor of Postoperative Opioid Use and Opioid Use Disorder: A Cohort Study
J Gen Intern Med. 2020 Jun 24. doi: 10.1007/s11606-020-06001-y.
Yuhree Kim 1 2, Fang Zhang 1, Katherine Su 1 2, Marc LaRochelle 3, Matthew Callahan 1, David Fisher 2, J Frank Wharam 1, Maryam M Asgari 4 5
- Reduced palliative cancer pain after Vitamin D supplementation – April 2016
- Hypothesis: Drug addiction in humans can be prevented and treated by vitamin D -May 2014
- Off Topic: 4X increase in Americans taking morphine-type drugs in last decade (consider Vitamin D instead) – Aug 2014
- Mistreated – book by Dr. Robert Pearl - May 2017
- "Opiate use is now the most common cause of death from injury in the US."
- Opioid use in palliative cancer patients far less if high level of vitamin D – May 2015
- Overview Pain and Vitamin D
- Chronic Pain reported 38 percent less often if supplemented with Vitamin D – meta-analysis Sept 2016
- Palliative cancer benefit of 4,000 IU of Vitamin D – less opioids, infection, and CRP – Aug 2017
Chart showing decreased use of Opiates among Cancer patients taking vitamin D
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 25-hydroxyvitamin 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. Serum 25D levels may serve as a biomarker to identify subjects at increased risk of opioid misuse.