Authorizing a second opioid prescription in opioid-naive adults doubles the risk for chronic opioid use, according to an MMWR study.
Researchers examined a sample of 1.3 million U.S. adults who were prescribed opioids for the first time between 2006 and 2015. Of these, the probability of continued opioid use 1 year later was 6%, and 3 years later, 3%. Of those who refilled a prescription, roughly 14% were still taking opioids at 1 year. Those given a longer supply in their first prescription also had higher rates of chronic use.
Long-acting opioids and tramadol had the highest probabilities of long-term use (27% and 14% at 1 year). Tramadol was unexpected given its limited affinity for the µ-opioid receptor, the authors note.
They reiterate: “Treatment of acute pain with opioids should be for the shortest durations possible. Prescribing <7 days (ideally ≤3 days) of medication when initiating opioids could mitigate the chances of unintentional chronic use. When initiating opioids, caution should be exercised when prescribing >1 week of opioids or when authorizing a refill or a second opioid prescription … 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.”
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