Dataset Information

Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naive Patients: A Statewide Retrospective Cohort Study.

ABSTRACT:

Background

Long-term efficacy of opioids for non-cancer pain is unproven, but risks argue for cautious prescribing. Few data suggest how long or how much opioid can be prescribed for opioid-naïve patients without inadvertently promoting long-term use.

Objective

To examine the association between initial opioid prescribing patterns and likelihood of long-term use among opioid-naïve patients.

Design

Retrospective cohort study; data from Oregon resident prescriptions linked to death certificates and hospital discharges.

Participants

Patients filling opioid prescriptions between October 1, 2012, and September 30, 2013, with no opioid fills for the previous 365 days. Subgroup analyses examined patients under age 45 who did not die in the follow-up year, excluding most cancer or palliative care patients.

Main measures

Exposure: Numbers of prescription fills and cumulative morphine milligram equivalents (MMEs) dispensed during 30 days following opioid initiation ("initiation month").

Outcome

Proportion of patients with six or more opioid fills during the subsequent year ("long-term users").

Key results

There were 536,767 opioid-naïve patients who filled an opioid prescription. Of these, 26,785 (5.0 %) became long-term users. Numbers of fills and cumulative MMEs during the initiation month were associated with long-term use. Among patients under age 45 using short-acting opioids who did not die in the follow-up year, the adjusted odds ratio (OR) for long-term use among those receiving two fills versus one was 2.25 (95 % CI: 2.17, 2.33). Compared to those who received?ConclusionsEarly opioid prescribing patterns are associated with long-term use. While patient characteristics are important, clinicians have greater control over initial prescribing. Our findings may help minimize the risk of inadvertently initiating long-term opioid use.

SUBMITTER: Deyo RA

PROVIDER: S-EPMC5215151 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients: A Statewide Retrospective Cohort Study.

Deyo Richard A RA Hallvik Sara E SE Hildebran Christi C Marino Miguel M Dexter Eve E Irvine Jessica M JM O'Kane Nicole N Van Otterloo Joshua J Wright Dagan A DA Leichtling Gillian G Millet Lisa M LM

Journal of general internal medicine 20160802 1

<h4>Background</h4>Long-term efficacy of opioids for non-cancer pain is unproven, but risks argue for cautious prescribing. Few data suggest how long or how much opioid can be prescribed for opioid-naïve patients without inadvertently promoting long-term use.<h4>Objective</h4>To examine the association between initial opioid prescribing patterns and likelihood of long-term use among opioid-naïve patients.<h4>Design</h4>Retrospective cohort study; data from Oregon resident prescriptions linked to ...[more]

PMID: 27484682

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