March 22, 2017

It doesn't take long to be at risk of long-term opioid use, CDC says

Daily Briefing

The probability that an individual will use opioids long term starts to increase within just a few days of taking a prescribed opioid drug, according to CDC's Morbidity and Mortality Weekly Report published Friday.

Report details

For the report, CDC researchers reviewed data on more than one million individuals who received at least one opioid prescription between June 1, 2006, and Sept. 1, 2015. The researchers excluded data on individuals with cancer, as well as those with a substance use disorder. The data did not account for the cause or intensity of patients' pain, which might have influenced the report's results, the Washington Post's "To Your Health" reports.

Long-term use is use that lasts for at least one year, according to Bradley Martin, a co-author of the report and a professor of pharmaceutical evaluation and policy at University of Arkansas for Medical Sciences.

Key findings

Overall, the researchers found that 2.6 percent of the sample population used opioids for longer than one year. When compared with individuals who did not use opioids long term, those who did were more likely to:

  • Be enrolled in a public health plan or be self-insured;
  • Be female;
  • Be older;
  • Have been prescribed a long-acting opioid;
  • Have been diagnosed with pain before they started using opioids; and
  • Have begun using opioids at a higher prescribed dosage.

The researchers found that the rate of long-term opioid use was "relatively low," at 6 percent, among individuals whose first episodes of opioid therapy lasted for at least one day. However, the rate of long-term opioid use grew to:

  • 13 percent among individuals whose first episodes of opioid therapy lasted for at least eight days; and
  • 29.9 percent among individuals whose first episodes of opioid therapy lasted for at least 31 days.

According to the researchers, "The probability of long-term opioid use increases most sharply in the first days of therapy, particularly after five days or one month of opioids have been prescribed, and levels off after approximately 12 weeks of therapy." They added, "Transitions from acute to long-term therapy can begin to occur quickly: the chances of chronic use begin to increase after the third day supplied and rise rapidly thereafter."

Further, the researchers found that about one in seven individuals who received a second opioid prescription or a refill used opioids long-term. According to the researchers, the greatest incremental increases in the likelihood individuals would use opioids long-term occurred when individuals:

  • Received an initial opioid prescription for longer than 10 or 30 days;
  • Received a third opioid prescription; and
  • Were prescribed an opioid with a cumulative dose of 700 mg of morphine equivalents or higher.

Comments

The researchers said providers should follow CDC guidelines for prescribing opioids and prescribe the drugs only "for the shortest durations possible" to treat acute pain. They added that prescribing fewer than seven days' worth of opioids—or ideally no more than three days' worth—when patients first begin opioid therapy "could mitigate the chances of unintentional chronic use."

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In addition, Martin said providers should discuss long-term opioid use with patients "early in the opioid-prescribing process."

However, Hanna Grol-Prokopczyk, a medical sociologist at the University at Buffalo who was not involved with the report, cautioned that limiting patients' access to opioids should not be the only steps providers take to address long-term opioid use. She said, "Let's recognize that we need to invest in either figuring out how to prevent chronic pain or treat(ing) it in a way that doesn't have all the deleterious effects of opioids" (Frostenson, Vox, 3/20; Zimmerman, Becker's Hospital Review, 3/17; Naqvi, "To Your Health," Washington Post, 3/17; Shah et al., CDC's Morbidity and Mortality Weekly Report, 3/17).

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