Physicians might control long-term opioid use through initial prescribing habits, study says
Researchers concluded that the probability of long-term opioid use can be minimized by starting with a single prescription of a short-acting opioid, with no refills, and a cumulative dose less than 120 morphine milligram equivalents.
Early opioid prescribing patterns are associated with long-term use, a study found, as patients starting with long-acting opioids may have a higher risk of long-term use than those beginning with short-acting ones.
Researchers conducted a retrospective cohort study of data from Oregon resident prescriptions linked to death certificates and hospital discharges among patients filling opioid prescriptions between October 2012 and September 2013 who had had no opioid fills in the previous year. Numbers of prescription fills and cumulative morphine milligram equivalents (MMEs) dispensed during the 30 days following the start of opioids (“initiation month”) and the proportion of patients with 6 or more opioid fills during the subsequent year (“long-term users”) were examined. Study results were published online Aug. 2 by the Journal of General Internal Medicine.
In the study, 536,767 patients filled an opioid prescription, and of these, 26,785 (5.0%) became long-term users. Long-term use was associated with numbers of fills and cumulative MMEs during the initiation month. In patients younger than age 45 who used short-acting opioids and did not die in the follow-up year, the adjusted odds ratio (OR) for long-term use was 2.25 (95 % CI, 2.17 to 2.33) among those receiving 2 fills versus 1. Compared to those who received less than 120 total MMEs, the OR for long-term use among those who received between 400 and 799 was 2.96 (95 % CI, 2.81 to 3.11).
“For most patients initiating opioids, the intention is short-term use,” the authors wrote. “Our data suggest that the probability of long-term use can be minimized by initiation with a single prescription of a short-acting opioid, with no refills, and a cumulative dose less than 120 morphine equivalents. An example would be a regimen of 10 mg hydrocodone tablets prescribed 4 times daily for 3 or fewer days. The increasing risk of long-term use even at low cumulative doses supports the CDC recommendation of limiting therapy to 3 to 7 days for most patients.”