Marilyn M. Heng, MD, MPH, FRCSCOrthopaedic Trauma SurgeonAssistant Professor of Orthopaedic SurgeryHarvard Medical School

Addiction Risk: No One Opioid Safer Than Other After Surgery Interview with:

Marilyn M. Heng, MD, MPH, FRCSCOrthopaedic Trauma SurgeonAssistant Professor of Orthopaedic SurgeryHarvard Medical School

Dr. Heng

Marilyn M. Heng, MD, MPH, FRCSC
Orthopaedic Trauma Surgeon
Assistant Professor of Orthopaedic Surgery
Harvard Medical School What is the background for this study?  

Response: The ultimate background for this study does come from the larger context of the opioid epidemic that is seen worldwide but particularly in North America. Orthopaedic surgeons should take responsibility as being among the top prescribers of opioids.

The more specific background that led to this specific study was the observation that several colleagues would insist that a drug like hydromorphone was so dangerous that they would not prescribe it but seemed okay prescribing large amounts of oxycodone.  It seemed like an urban myth that the type of opioid was what made it dangerous, so that led us to do the study to see if there was evidence for that. What are the main findings?

Response: What our results demonstrated was that, indeed as we hypothesized, it was not the type of opioid that was inherently a risk factor but rather that prolonged opiate use correlates with the overall amount of opioid (standardized in measurement by morphine milligram equivalents (MMEs) prescribed at discharge.  We identified a pattern where simply the stronger opioids like hydromorphone were being prescribed at higher dosages likely because of a failure to properly calculate an equivalence dose among the different opioid types.  Once we controlled for the MMEs being prescribed there was not a difference in risk for prolonged use based just on opioid type. What should readers take away from your report? 

Response: The main take away should be that there is not an opioid that is “safer” than another, but rather it is the amount of opioid that a patient is taking that will influence their risk for long term use.  Providers who prescribe opioids should be aware of equivalence dosing and properly calculate how much MME a patient is being prescribed rather than thinking solely in terms of number of tablets of the drug. What recommendations do you have for future research as a result of this work> 

Response: We should continue to do future research in terms of non-opioid alternatives for pain management in orthopaedic surgery to attempt to continue to prevent patients from becoming prolonged users.  However, we should also recognize that to a certain degree, the problem of prolonged opioid users already exists and we will continue to see patients with these issues present for orthopaedic surgery, so future research with respect to effective opioid addiction treatment is direly needed. Is there anything else you would like to add?

Response: No conflicts of interest to disclose. Matthew Basilico received funding to perform this work from a predoctoral fellowship in Aging and Health Economics (NIA T32 AG 51108 grant from the National Institute on Aging.  The content of article and above responses do not necessarily represent official views of National Institute on Aging or the NIH.


Am Acad Orthop Surg. 2019 May 1;27(9):e423-e429. doi: 10.5435/JAAOS-D-17-00663.

Prescription Opioid Type and the Likelihood of Prolonged Opioid Use After Orthopaedic Surgery.

Basilico M]1, Bhashyam AR, Harris MB, Heng M.

[wysija_form id=”3″]


The information on is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.


Last Updated on May 16, 2019 by Marie Benz MD FAAD