The data are provided in a deidentified format and the institutional review board at the authors’ institution deemed the study was not human subject research. By providing quantitative evidence on risk for long-term use based on initial prescribing characteristics, these findings might inform opioid prescribing practices.Ī random 10% sample of patient records during 2006–2015 was drawn from the IMS Lifelink+ database, which includes commercial health plan information from a large number of managed care plans and is representative of the U.S. The largest increments in probability of continued use were observed after the fifth and thirty-first days on therapy the second prescription 700 morphine milligram equivalents cumulative dose and first prescriptions with 10- and 30-day supplies.
Patient records from the IMS Lifelink+ database were analyzed to characterize the first episode of opioid use among commercially insured, opioid-naïve, cancer-free adults and quantify the increase in probability of long-term use of opioids with each additional day supplied, day of therapy, or incremental increase in cumulative dose.
However, data quantifying the transition from acute to chronic opioid use are lacking. Discussions with patients about the long-term use of opioids to manage pain should occur early in the opioid prescribing process.īecause long-term opioid use often begins with treatment of acute pain ( 1), in March 2016, the CDC Guideline for Prescribing Opioids for Chronic Pain included recommendations for the duration of opioid therapy for acute pain and the type of opioid to select when therapy is initiated ( 2). Knowledge that the risks for chronic opioid use increase with each additional day supplied might help clinicians evaluate their initial opioid prescribing decisions and potentially reduce the risk for long-term opioid use. What are the implications for public health practice?Īwareness among prescribers, pharmacists, and persons managing pharmacy benefits that authorization of a second opioid prescription doubles the risk for opioid use 1 year later might deter overprescribing of opioids. 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 a representative sample of opioid naïve, cancer-free adults who received a prescription for opioid pain relievers, the likelihood of chronic opioid use increased with each additional day of medication supplied starting with the third day, with the sharpest increases in chronic opioid use observed after the fifth and thirty-first day on therapy, a second prescription or refill, 700 morphine milligram equivalents cumulative dose, and an initial 10- or 30-day supply. Early opioid prescribing patterns for opioid-naïve patients have been found to be associated with the likelihood of long-term use.
Based on the CDC Guideline for Prescribing Opioids for Chronic Pain, literature supporting long-term opioid therapy for pain is limited research suggests an increased risk for harms with long-term opioid use.
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