Opioid Prescribing Patterns in Women Who Have Undergone Mastectomy

In recent years, the prescription of opioid painkillers has risen significantly in many countries, accompanied by an alarming increase in opioid-related deaths. In France, between 2000 and 2015, the number of deaths attributable to opioids rose by 146%, highlighting the growing scale of this public health problem. Opioid use disorder (OUD), defined by the DSM-5 as persistent use despite negative consequences, is now a global concern. While the risks associated with these prescriptions have been extensively studied in the context of non-cancer chronic pain, few reliable data currently exist on OUD in the context of cancer-related chronic pain, particularly among women with breast cancer.

These patients represent the second-largest population of cancer survivors, and many of them must cope with persistent iatrogenic pain induced by treatments, particularly hormone therapy. This chronic pain significantly affects their quality of life, both functionally and emotionally. Yet, the management of this pain still often relies on opioids, despite their limited efficacy in this specific context. Continuing these long-term treatments could thus expose these women to an increased risk of developing OUD, a risk that has not yet been sufficiently explored in the current literature.

The primary objective of this study is to describe the patterns of opioid analgesic dispensing, up to 1 year, among these women who underwent surgery for breast cancer.

The main secondary objectives will be to evaluate the patterns of administration of other medications such as anxiolytics, antidepressants (distinguishing between mood-stabilizing antidepressants and those used for neuropathic pain), antiepileptics used for neuropathic pain (gabapentin and pregabalin), antipsychotics, and hypnotics for up to 1 year in these women who underwent surgery for breast cancer.

This is a pharmacoepidemiological, longitudinal cohort study utilizing the SNDS databases (National Health Data System). The SNDS covers approximately 99% of the French population, or 66 million people. It contains comprehensive, anonymous individual data on reimbursed outpatient healthcare expenditures (SNIIRAM), including medications dispensed by pharmacies.