Individuals prescribed long-acting opioids are more likely to have chronic opioid use, according to a new report published by the Centers for Disease Control and Prevention.
The report said the likelihood of chronic opioid use increased with each additional day of medication supplied beginning with the third day. These findings corroborate previous research in which early opioid prescribing patterns for first time opioid patients have been found to be linked to the probability of long-term use.
The study, published in he CDC’s Morbidity and Mortality Weekly Report, involved a review of data on 1,294,247 patients, including 33,548 (2.6%) who continued opioid therapy for ≥1 year.
Chronic Opioid Use
The sharpest increases in chronic opioid use were observed after:
A second prescription or refill
The fifth and thirty-first days of therapy
An initial 10- or 30-day supply
700 morphine milligram equivalents cumulative dose
The highest probability of continued opioid use after both 1 and 3 years was observed in patients who were initially prescribed a long-acting opioid, followed by patients who were started on tramadol.
Despite tramadol being known as a relatively safe opioid with low abuse potential, the unexpected result was that approximately 64% of patients who continued opioid use beyond 1 year were still on tramadol. One possible reason for this, the researchers wrote, is that tramadol might be prescribed intentionally for chronic pain management.
[caption id=“attachment_89025” align=“aligncenter” width=“680”] One- and 3-year probabilities of continued opioid use among opioid-naïve patients, by number of days’ supply* of the first opioid prescription — United States, 2006–2015. CDC[/caption]
The study concludes that when beginning opioids, physicians should exercise caution when prescribing more than 1 week of opioids or authorizing a refill or second opioid prescription, since doing so approximately doubles the chances of use 1 year later.
Also, discussions with patients about the long-term use of opioids to manage pain should occur early in the opioid prescribing process.
From 2000 to 2014, according to the CDC, nearly half a million persons in the United States died from drug overdoses. Opioids, primarily prescription pain relievers and heroin, are the main drugs associated with these overdose deaths. In 2014, there were approximately one and a half times more drug overdose deaths in the United States than deaths from motor vehicle crashes.
Shah A, Hayes CJ, Martin BC Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015 MMWR Morb Mortal Wkly Rep 2017;66:265–269. DOI: http://dx.doi.org/10.15585/mmwr.mm6610a1