The likelihood of chronic opioid use in patients increased with each additional day of medication supplied starting with the third day and saw sharper increases as time went on, according to research recently published in Morbidity and Mortality Weekly Report.
“Data quantifying the transition from acute to chronic opioid use are lacking,” Anuj Shah, a PhD student in the division of pharmaceutical evaluation and policy, College of Pharmacy, University of Arkansas for Medical Sciences, and colleagues wrote.
To get more information on the subject, Shah and colleagues studied more than 1.2 million patient records randomly chosen from the IMS Lifelink+ database, which researchers said contains information on commercial health plan information from a large number of managed care plans and is representative of the U.S. commercially insured population . All the patients were aged 18 and older, had at least one opioid prescription from June 1, 2006, to Sept. 1, 2015 and were enrolled continuously for at least 6 months before their first opioid prescription.
Patients who had any cancer (besides nonmelanoma skin cancer) or a substance abuse disorder diagnosis in the 6 months before their first opioid prescription, or whose first prescription was for any buprenorphine formulation indicated for treatment of substance abuse were excluded. The patients were observed from the date of their first prescription until loss of enrollment, study end date, or discontinuation of opioids, which was defined as 180 days or more without opioid use.
The researchers found that the likelihood of chronic opioid use increased with each additional day of medication supplied starting with the third day, with sharper increases in chronic opioid use observed after the 5th and 31st day on therapy, after a second prescription or refill, a 700 morphine mg equivalent cumulative dose, and an initial 10- or 30-day supply. The highest probability of continued opioid use at 1 and 3 years was observed among patients who started on a long-acting opioid followed by patients who started on tramadol. In addition, patients who were older, female, had a pain diagnosis before opioid initiation, were initiated on higher doses of opioids, and were publicly or self-insured, were more likely to continue opioid therapy for 1 year or more compared with patients who discontinued opioid use in less than 365 days.
Previous research that recently appeared in the New England Journal of Medicine, suggests patients treated in the ED by physicians who prescribe opioids at a higher intensity are at greater risk for long-term opioid use than those who see low-intensity prescribers
“Transitions from acute to long-term therapy can begin to occur quickly: the chances of chronic use begin to increase after the third day supplied and rise rapidly thereafter. Consistent with CDC guidelines, treatment of acute pain with opioids should be for the shortest durations possible,” Shah and colleagues wrote. “In addition, prescribers should discuss the long-term plan for pain management with patients for whom they are prescribing either Schedule II long-acting opioids or tramadol.”
Other research recently identified six potential ways that could lead to better outcomes in chronic opioid management, including calculating progress toward achieving clinic objectives and pinpointing resources for complex patients. -by Janel Miller
Healio Family Medicine was unable to determine the researchers’ relevant disclosures prior to publication.