Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Prescribing and Potential Long-Term Opioid Use
MMWR; ePub 2017 Mar 17; Shah, Hayes, et al
Authorization of a second opioid prescription doubles the risk for opioid use 1 year later, and awareness among prescribers may help prevent chronic opioid use in US patients. This according to a random 10% sample of patient records during 2006-2015 from the IMS Lifelink+ database. Patients were followed from the date of their first prescription until loss of enrollment, study end date, or discontinuation of opioids, which was defined as ≥180 days without opioid use. 1,294,247 patients met inclusion criteria, including 33,548 (2.6%) who continued opioid therapy for ≥1 year. Researchers found:
- Patients who continued opioid therapy for ≥1 year were more likely to be older, female, have a pain diagnosis before opioid initiation, and initiated on higher doses of opioids, compared to patients who discontinued opioid use in <365 days.
- The largest incremental increases in the probability of continued opioid use were observed when the first prescription supplied exceeded 10 or 30 days, when a patient received a third prescription, or when the cumulative dose was ≥700 morphine milligram equivalents.
- 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.
Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid us —United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017;66:265–269. doi:10.15585/mmwr.mm6610a1.
This Week's Must Reads
Must Reads in Addiction Medicine
Acute Illness and Cannabis Use in Adults, Ann Intern Med; ePub 2019 Mar 26; Monte, et al
Dual Receipt of Rx Opioids & Overdose Death, Ann Intern Med; ePub 2019 Mar 12; Moyo, et al
Opioid-Related Mortality in US by Opioid Type, JAMA Netw Open; 2019 Feb 22; Kiang, et al
Disparities in the Prescription of Opioids, JAMA Intern Med; ePub 2019 Feb 11; Friedman, et al
Prevention of Prescription Opioid Misuse in the US, JAMA Netw Open; 2019 Feb 1; Chen, et al
Managing pain is challenging. Approximately 20% of patients presenting to physician offices with non-cancer pain (including acute and chronic pain) receive an opioid prescription.1 The specificity of the information in this article is helpful and alerts us to the increasing likelihood of long-term use when the initial prescription for opioids exceeds either 5 days or 1 month of therapy. These are time markers in which we should stand back, think, and to discuss this serious issue with patients. The instance in which a patient needs a refill of an opioid used for acute management of pain is a time marker to have a discussion with the patient about other strategies for pain control, as the risk of long-term use increases after that first refill, with 1 in 7 persons who receive a refill of an opioid prescription for chronic pain remaining on opioids a year later. A refill for a second prescription for opioid treatment during an episode of pain approximately doubles the risk for use 1 year later. Current CDC guidelines for prescribing opioids recommend prescribing opioids for the shortest duration of time possible, 3-7 days.2 Patients who need a refill of their opioid prescription should probably be seen back in the office for re-evaluation and discussion. —Neil Skolnik, MD