Initial Opioid Prescription May Affect Long-Term Use

The odds of long-term opioid use increased most sharply in the first days of therapy, particularly after 5 days of taking the drugs.

Doctors who limit the supply of opioids they prescribe to 3 days or less may help patients reduce their risk of dependence and addiction, according to research published in the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.¹

Researchers looked at a sample of patients drawn from data from health insurers and managed care plans. Specifically, they looked at opioid use among patients not being treated for cancer. Among patients without cancer, a single day’s supply of an opioid can result in 6.0% of patients being on an opioid a year later, the researchers reported.

The odds of long-term opioid use increased most sharply in the first days of therapy, particularly after 5 days of taking the drugs. The rate of long-term opioid use increased to 13.5% for patients who first took the drugs for 8 days or more. The highest probability of continued opioid use at 1 and 3 years was seen among patients who started on a long-acting opioid, followed by patients who started on tramadol.

“Awareness 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. 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,” the authors write. “Discussions with patients about the long-term use of opioids to manage pain should occur early in the opioid prescribing process.”

Reference

1. 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 Rep2017;66:265–269.