The Prevalence of Substance Abuse among Elective Surgical Inpatients in Teaching Hospitals in Kerman, Iran

Background: Opioid abuse prior to hospitalization in patients undergoing surgical procedures is associated with challenges in pain management, determining anesthetic dose, and providing nursing care. This study aimed to evaluate opioid abuse/dependence in hospitalized patients undergoing major elective surgery. 
Materials and Methods: A total of 1000 patients who were candidates for major elective surgery were assessed for demographic characteristics, perioperative and postoperative pain management, type and route of opioid abuse, and the current use of other abused substances. 
Results: Substance abuse was observed in 34% of surgical inpatients. The mean duration of substance abuse was 4.3 } 1.9 years. Opioids were the most frequently abused substances (67.9%), followed by naswar (16.4%) and marijuana (8.5%). The inhalation route (60%) was the most common route for opioid use, followed by injection (29.4%) and oral route (10.6%). The prevalence of opioid abuse in females (54.6%) was significantly higher than males (45.4%), (P = 0.032, odd ratio =1.18, 95% CI = 1.03 -1.42). Low education level was associated with a higher rate of substance abuse (P = 0.042, Odd ratio=1.39, 95% CI = 1.14 -1.64), but there was no significant correlation between sex, education level, and substance abuse type. Overall, opioid abuse and dependence were associated with at least a 30% increase in the need for opioid analgesics to relieve postoperative pain. No opioid withdrawal signs were recorded in opioid-abusing patients. 
Conclusion: The results showed substance/drug abuse in more than one-third of surgical inpatients (34%) and a higher rate of drug abuse in women, which was an unexpected finding. Opioid abuse was significantly associated with education level. Opioid-dependent patients received higher doses of opioids during postoperative periods. Since opioid abuse can affect both preoperative and postoperative surgical and nursing health professionals, especially nurses, need continued medical education and professional support in caring for these individuals.