PERSISTENT OPIOID USE AFTER ORTHOPEDIC FRACTURES: RISK FACTORS, DEPENDENCE, AND WEANING STRATEGIES – AN INTEGRATIVE REVIEW (2020–2025)

Abstract

Persistent opioid use following fractures and orthopedic procedures has increasingly become a significant public health concern due to its association with medication dependence, clinical complications, and negative impacts on patients' functional recovery. This study aimed to identify the main risk factors associated with persistent opioid use after orthopedic fractures, as well as to analyze the consequences of dependence and the prevention and tapering strategies described in the scientific literature. This is an integrative literature review with a descriptive and qualitative approach, conducted using the PubMed, SciELO, LILACS, and Google Scholar databases. Studies published between 2020 and 2025, available in full text and written in Portuguese or English, addressing persistent opioid use following trauma or orthopedic procedures were included. After applying the eligibility criteria, seven studies were selected for the final sample out of 194 records initially identified. The findings revealed that the main factors associated with persistent opioid use were previous opioid exposure, chronic pain, psychological disorders, advanced age, multiple comorbidities, and excessive postoperative prescriptions. The most frequently reported consequences included physical and psychological dependence, increased tolerance, withdrawal syndrome, intoxication, overdose, and impaired functional recovery. The most effective strategies for preventing and reducing prolonged opioid use involved multimodal analgesia, patient education, continuous prescription monitoring, and multidisciplinary follow-up. It is concluded that the implementation of evidence-based clinical protocols is essential to promote the rational use of opioids, minimize the risks associated with dependence, and improve clinical outcomes in orthopedic patients.