Report: Risk of long-term opioid use increases in initial week of treatment

Findings released this week by the Centers for Disease Control and Prevention (CDC) clearly illustrate why many health authorities, and now some state governments, support strict limits on initial supplies of opioid medications.

Data published in the CDC's March 17 Morbidity and Mortality Weekly Report conclude that the probability of long-term opioid use increases most dramatically in the first days of therapy, particularly after five days or one month of opioids have been prescribed. While only 6% of patients receiving at least one day of opioid therapy remained on opioids a year later, the percentage of such long-term users increased to just under 30% when the first treatment episode was at least 31 days.

The findings were based on a database review of a random sample of patient records covering the period from 2006-2015, encompassing nearly 1.3 million people who received an opioid prescription in that period.

“Discussions with patients about the long-term use of opioids to manage pain should occur early in the opioid prescribing process, perhaps as early as the first refill, because approximately 1 in 7 persons who received a refill or had a second opioid prescription authorized were on opioids 1 year later,” the report states.

New Jersey lawmakers recently adopted broad legislation designed to combat the opioid crisis, a measure that includes a five-day limit on initial opioid prescriptions.

Facts about study

The researchers excluded from the study sample individuals with a diagnosed substance use disorder in the six months preceding their first opioid prescription, as well as patients with cancer and anyone whose first opioid prescription was for a buprenorphine product.

They found that patients who continued to receive opioid treatment for at least a year were more likely to be women, older, have a pain diagnosis before receiving opioid therapy, and be initiated on higher doses of opioids.

The individuals most likely to have continued opioid use at one and three years were those who had initiated treatment with a long-acting opioid and those who had initially received the opioid tramadol. Study authors said the former finding was expected but the latter was not.

They wrote that “because of tramadol's minimal affinity for the µ-opioid receptor, it is deemed a relatively safe opioid agonist with lower abuse potential than other opioids.” They added, however, that federal data have confirmed significant increases in hospital emergency visits related to tramadol in the period from 2005-2011.

The authors concluded that prescribing a less than seven-day dose of opioids initially can lessen the chances of unintended chronic use, and they said that ideally the initial dose should be no longer than three days.