One in Thirty-Five Swedish Surgery Patients Was Still Collecting Opioids Six Months Later

Sweden fills far fewer opioid prescriptions than the United States, which is why the number in Claes Gedda's doctoral thesis is worth sitting with. Of 1,245,211 adults who had surgery between 2018 and 2022 and had not been collecting opioids for most of the preceding year, 35,132 — 2.82 percent — were still filling prescriptions both during the first three months after their operation and again in months four through six.

Gedda, whose thesis was published this week at Karolinska Institutet's Department of Clinical Sciences at Danderyd Hospital and will be defended December 4, puts that in annual terms: roughly 7,000 people a year in Sweden continue collecting opioids long after recovery from surgery should have ended. The cohort excluded anyone with substantial prior opioid use, so these are new persistent users, not patients returning to an old prescription.

Who the risk clustered around

The thesis found the risk was not evenly distributed. Older patients and those with greater comorbidity were more likely to keep filling. So were people with a recent cancer diagnosis, chronic pain, anxiety or depression, and those with documented alcohol or drug problems. Emergency surgery carried a higher risk than planned procedures.

The single strongest signal was early: patients who collected opioids during the first week after surgery were more than twice as likely to still be collecting them months later. That is a correlational finding, and the thesis does not claim otherwise — early refills may mark a harder recovery as easily as they cause one. But it does mean the prescribing decision in week one carries information about month five.

Gedda's framing is that part of this is predictable before the operation and part of it is a choice the health system makes afterward. "Post-operative prescribing is a factor that the healthcare system can actually influence," he said.

The prescribing lever the thesis tested

The second half of the work is a before-and-after study of 842 patients who had major colon and rectal surgery, where opioids were given on an as-needed basis instead of on a fixed schedule, alongside other pain-relieving drugs. Over four years, median opioid consumption fell by 70 percent, and by the end of the period nearly one in three patients received no opioids at all during the first six days after surgery.

That is a large change from a scheduling decision rather than a new drug. It also comes with an honest limit that Gedda states himself: whether less early exposure translates into less long-term use has not been established, and testing it is the next question. Reduced consumption in the days after colorectal surgery is not the same endpoint as the 2.82 percent persistence figure, and the thesis does not merge the two.

For U.S. readers the arithmetic is a provocation rather than a template. The American surgical population is roughly sixty times Sweden's, opioid prescribing after discharge varies by surgeon and by state rather than by protocol, and much of the excess supply after surgery has historically moved into households where someone other than the patient later uses it. The takeaway that transfers cleanly is the surveillance one: new persistent use after surgery is measurable in a national registry, it clusters in identifiable patients, and the heaviest predictor is visible within seven days. For anyone who does develop prescription drug dependence on that path, the dependence usually begins with a legitimate prescription and an ordinary recovery. Treatment for opioid addiction works better the earlier it starts, and this thesis suggests the clock can be read sooner than most discharge planning assumes.