Original articles|Articles in Press

The impact of bariatric surgery on opioid consumption in patients with obesity: a registry-based cohort study

  • Pouya Iranmanesh
    Contact Information: Pouya Iranmanesh, MD FACS, Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland, Phone number: +41 22 372 13 78.
    Center for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada

    Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
    Search for articles by this author
  • Karen Barlow
    Center for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
    Search for articles by this author
  • Mehran Anvari
    Center for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
    Search for articles by this author


      • The prevalence of opioid usage among patients with obesity is higher than the general population
      • This study shows a significant decrease in the consumption of opioid medication after bariatric surgery
      • Bariatric surgery could be an additional tool to fight the current opioid crisis



      Misuse of opioid medication has become a major health crisis in several countries. A significant number of patients with obesity use opioid medications, mostly to alleviate symptoms due to obesity-related comorbidities.


      To compare patterns of opioid drugs usage before and after bariatric surgery in this population, hypothesizing that weight loss and improvement of obesity-related comorbidities could reduce opioid consumption.


      The Ontario Bariatric Registry (Ontario, Canada).


      In this retrospective cohort study, the Ontario Bariatric Registry was used to compare opioid consumption in adult patients undergoing bariatric surgery between 2010 and 2021. The primary outcome was the number of patients using opioid medication at 1-year after surgery. Multiple logistic regression analyses were performed to identify potential predictors of opioid consumption.


      Data of 11’179 patients were analyzed. Mean age was 45.7±10.2 years, mean baseline BMI was 48.9±8 kg/m2 and 83.6% of patients were female. Roux-en-Y gastric bypass was performed in the majority of patients (85.6%), followed by sleeve gastrectomy (14.2%). At baseline, opioids were used by 7.7% and non-opioid pain medications by 42.3% of patients. At 1-year after surgery, these numbers significantly decreased (Δ-1.9% and Δ-18.0% respectively). The decrease in the consumption of non-opioid pain medication needs to be interpreted in the context of the contraindication to non-steroidal anti-inflammatory drugs after RYGB, which was the most commonly performed procedure. Presence of musculoskeletal pain and use of non-opioid pain medication at baseline were identified as independent predictors of opioid consumption at 1-year after surgery.


      At 1-year after bariatric surgery, a significant decrease in opioid and non-opioid pain medication consumption was seen among patients with obesity. Aggressive management of excess weight, especially with bariatric surgery, can potentially reduce the impact of the opioid crisis in this population.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. HHS Acting Secretary Declares Public Health Emergency to Address National Opioid Crisis, October 26, 2017. Accessed December 15, 2022.

      2. Centers for Disease Control and Prevention. Leveraging Prescription Drug Monitoring Program (PDMP) Data in Overdose Prevention and Response. Atlanta, GA. National Center for Injury Prevention and Control, Division of Overdose Prevention, 2021.

      3. Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999–2019. NCHS Data Brief, no 394. Hyattsville, MD. National Center for Health Statistics, 2020.

      4. Hedegaard H, Miniño AM, Spencer MR, et al. Drug overdose deaths in the United States, 1999–2020. NCHS Data Brief, no 428. Hyattsville, MD. National Center for Health Statistics, 2021.

        • De Sola H
        • Dueñas M
        • Salazar A
        • et al.
        Prevalence of Therapeutic use of Opioids in Chronic non-Cancer Pain Patients and Associated Factors: A Systematic Review and Meta-Analysis.
        Front Pharmacol. 2020 Nov 18; 11564412
      5. The Organisation for Economic Co-operation and Development (OECD), Obesity Update 2017. Accessed December 15, 2022.

      6. Stierman B, Afful J, Carroll MD, et al. National Health and Nutrition Examination Survey 2017–March 2020 prepandemic data files—Development of files and prevalence estimates for selected health outcomes. National Health Statistics Reports; no 158. Hyattsville, MD. National Center for Health Statistics, 2021.

        • Acosta MC
        • Manubay J
        • Levin FR
        Pediatric obesity: parallels with addiction and treatment recommendations.
        Harv Rev Psychiatry. 2008; 16: 80-96
        • Kalarchian MA
        • Marcus MD
        • Levine MD
        • et al.
        Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status.
        Am J Psychiatry. 2007; 164: 328-334
        • Grucza RA
        • Krueger RF
        • Racette SB
        • Norberg KE
        • Hipp PR
        • Bierut LJ
        The emerging link between alcoholism risk and obesity in the United States.
        Arch Gen Psychiatry. 2010; 67: 1301-1308
        • Denoth F
        • Siciliano V
        • Iozzo P
        • Fortunato L
        • Molinaro S
        The association between overweight and illegal drug consumption in adolescents: is there an underlying influence of the sociocultural environment?.
        PLoS One. 2011; 6 (Epub 2011 Nov 16)e27358
        • Gearhardt AN
        • Corbin WR
        • Brownell KD
        Food addiction: an examination of the diagnostic criteria for dependence.
        J Addict Med. 2009; 3: 1-7
        • Hajnal A
        • Smith GP
        • Norgren R
        Oral sucrose stimulation increases accumbens dopamine in the rat.
        Am J Physiol Regul Integr Comp Physiol. 2004; 286: R31-R37
        • Liu Y
        • von Deneen KM
        • Kobeissy FH
        • Kobeissy FH
        • Gold MS
        Food addiction and obesity: evidence from bench to bedside.
        J Psychoactive Drugs. 2010; 42: 133-145
      7. Hoebel B, Rada PV, Mark GP, et al. (1999). Neural systems for reinforcement and inhibition of behavior: Relevance to eating, addiction and depression. In Kahneman D, Diener E, Schwarz N, eds. Well being: Foundations of hedonic psychology. New York, NY: Russell Sage Foundation;1999: 558 –572.

        • Hitt HC
        • McMillen RC
        • Thornton-Neaves T
        • Koch K
        • Cosby AG
        Comorbidity of obesity and pain in a general population: results from the Southern Pain Prevalence Study.
        J Pain. 2007; 8: 430-436
        • Joaquim AF
        • Helvie P
        • Patel AA
        Bariatric Surgery and Low Back Pain: A Systematic Literature Review.
        Global Spine J. 2020; 10: 102-110
        • Vincent HK
        • Ben-David K
        • Conrad BP
        • Lamb KM
        • Seay AN
        • Vincent KR
        Rapid changes in gait, musculoskeletal pain, and quality of life after bariatric surgery.
        Surg Obes Relat Dis. 2012; 8: 346-354
        • Stokes A
        • Berry KM
        • Collins JM
        • et al.
        The contribution of obesity to prescription opioid use in the United States.
        Pain. 2019; 160: 2255-2262
        • Buchwald H.
        Consensus conference panel. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers.
        Surg Obes Relat Dis. 2005; 1: 371-381
        • Sjöström L
        • Narbro K
        • Sjöström CD
        • et al.
        Effects of bariatric surgery on mortality in Swedish obese subjects.
        N Engl J Med. 2007; 357: 741-752
        • Perry CD
        • Hutter MM
        • Smith DB
        • Newhouse JP
        • McNeil BJ
        Survival and changes in comorbidities after bariatric surgery.
        Ann Surg. 2008; 247: 21-27
        • Kubik JF
        • Gill RS
        • Laffin M
        • Laffin M
        • Karmali S
        The impact of bariatric surgery on psychological health.
        J Obes. 2013; 2013837989
        • Kakarla VR
        • Nandipati K
        • Lalla M
        • Castro A
        • Merola S
        Are laparoscopic bariatric procedures safe in superobese (BMI ≥50 kg/m2) patients? An NSQIP data analysis.
        Surg Obes Relat Dis. 2011 Jul-Aug; 7: 452-458
        • MacLean LD
        • Rhode BM
        • Nohr CW
        Late outcome of isolated gastric bypass.
        Ann Surg. 2000; 231: 524-528
        • Varela JE
        • Wilson SE
        • Nguyen NT
        Outcomes of bariatric surgery in the elderly.
        Am Surg. 2006 Oct; 72: 865-869
        • Adam S
        • Azmi S
        • Ho JH
        • et al.
        Improvements in Diabetic Neuropathy and Nephropathy After Bariatric Surgery: a Prospective Cohort Study.
        Obes Surg. 2021; 31: 554-563
        • Müller-Stich BP
        • Fischer L
        • Kenngott HG
        • et al.
        Gastric bypass leads to improvement of diabetic neuropathy independent of glucose normalization--results of a prospective cohort study (DiaSurg 1 study).
        Ann Surg. 2013; 258 (; discussion 765-6): 760-765
        • Howard R
        • Alameddine M
        • Klueh M
        • et al.
        Spillover Effect of Evidence-Based Postoperative Opioid Prescribing.
        J Am Coll Surg. 2018 Sep; 227: 374-381
        • Hill MV
        • Stucke RS
        • McMahon ML
        • et al.
        An Educational Intervention Decreases Opioid Prescribing After General Surgical Operations.
        Ann Surg. 2018 Mar; 267: 468-472
        • Herpertz S
        • Kielmann R
        • Wolf AM
        • Langkafel M
        • Senf W
        • Hebebrand J
        Does obesity surgery improve psychosocial functioning? A systematic review.
        Int J Obes Relat Metab Disord. 2003; 27: 1300-1314
        • van Hout GC
        • Boekestein P
        • Fortuin FA
        • Pelle AJ
        • van Heck GL
        Psychosocial functioning following bariatric surgery.
        Obes Surg. 2006; 16: 787-794
      8. The ministry of Health of Ontario, Canada. Physician Services Under the Health Insurance Act – Schedule of Benefits. October 5, 2022. Accessed on February 20, 2023.

        • Poole NA
        • Al Atar A
        • Kuhanendran D
        • et al.
        Compliance with surgical after-care following bariatric surgery for morbid obesity: a retrospective study.
        Obes Surg. 2005; 15: 261-265
        • Kolden GG
        • Howard KI
        • Bankoff EA
        Factors associated with treatment continuation: implications for the treatment of drug dependence.
        NIDA Res Monogr. 1997; 165: 110-130
        • Weiss RD
        • Greenfield SF
        • Najavits LM
        Medication compliance among patients with bipolar disorder and substance use disorder.
        J Clin Psychiatry. 1998; 59: 172-174