Prescribing practices influence opioid dependency
Patients provided with at least 2 refills were 2.25 times more likely to develop an opioid dependency.
HealthDay News — Patients who are first-time users of opioids should be prescribed a small dose without refills to reduce the risk of long-term use and possible addiction, according to a study published online August 2 in the Journal of General Internal Medicine.
Researchers analyzed data from 536,767 patients in Oregon who were prescribed opioids for the first time. The investigators found that 5% of those who received 6 or more refills within a year became long-term users. This trend was higher among rural patients (6.1%) than among urban patients (4.4%). And the risk of long-term use increased with age.
Further study of data from 243,427 patients aged 45 and younger found that those who were given 2 prescription fills were 2.25 times more likely to become long-term opioid users than those who received 1 prescription. The risk was also greater among patients who got higher initial doses and long-acting rather than short-acting medications.
The risk of long-term use can be reduced by prescribing a short-acting painkiller with no refills, according to study leader Richard Deyo, MD, MPH, a professor of evidence-based medicine at the Oregon Health & Science University in Portland. "The increasing risk of long-term use even at low cumulative doses supports the US Centers for Disease Control and Prevention recommendation of limiting therapy to 3 to 7 days for most patients," Deyo said in a journal news release. "Our data suggest the value of attention to high-risk prescribing, over which clinicians have greater control. This in part reflects concern that we are dealing with risky drugs, not risky patients."
- Deyo RA, Hallvik SE, Hildebran C, et al. Association between initial opioid prescribing patterns and subsequent long-term use among opioid-naive patients: A statewide retrospective cohort study. J Gen Intern Med. 2016; doi: 10.1007/s11606-016-3810-3