CDC: Risk of Chronic Opioid Use Linked to Long-Acting Opioids

According to a report from the CDC, risk of continued opioid use at 1 and 3 years is highest among individuals who initiated treatment with long-acting opioids.

“Because long-term opioid use often begins with treatment of acute pain, in March 2016, the CDC Guideline for Prescribing Opioids for Chronic Pain included recommendations for the duration of opioid therapy for acute pain and the type of opioid to select when therapy is initiated. However, data quantifying the transition from acute to chronic opioid use are lacking,” the authors wrote.
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The findings were based on a random 10% sample of patient records from the IMS Lifelink+ database from 2006 to 2016, and included commercially insured cancer-free adults (N=1,294,247) who had not previously taken opioids and were prescribed at least 1 opioid prescription during the study period. Patients were followed until loss of enrollment, discontinuation of opioid use for 180 days or more, or the end of the study.

Opioid prescriptions were classified as long-acting, oxycodone short-acting, hydrocodone short-acting, other Schedule II short-acting, Schedule III-IV and nalbuphine, and tramadol. The duration, number of prescriptions, and cumulative doses for the first opioid use were calculated, and the Kaplan-Meier statistic was used to estimated median time to discontinuation and probability of use at 1 year and 3 years.

Of the 1,294,247 patients included in the study, 33,548 (2.6%) had continued opioid therapy for 1 year or more. Patients with 1 year or more of opioid use were more likely to be older, female, have a pain diagnosis before opioid initiation, and were initiated on higher doses of opioids compared with patients who discontinued opioid use in less than a year.

In individuals prescribed at least 1 day of opioids, the probability of continued use at 1 year was 6% and at 3 years was 2.9%. Additionally, the largest incremental increases in the probability of continued opioid use were observed with first prescriptions that exceeded 10 or 30 days, or when a patient received a third prescription. Substantial increases in probabilities for continued use occurred when initial duration reached 6 and 31 days.

Overall, the findings demonstrated that patients who had initiated treatment with long-acting opioids had the highest probabilities of continued opioid use at 1 and 3 years (27.3% at 1 year; 20.5% at 3 years), followed by those treated with tramadol (13.7% at 1 year; 6.8% at 3 years) or a Schedule II short-acting opioid other than hydrocodone or oxycodone (8.9% at 1 year; 5.3% at 3 years). Likewise, the probabilities of continued use at 1 and 3 years for persons taking hydrocodone short-acting were 5.1% at 1 year and 2.4% at 3 years, and the probability for Schedule III-IV was 5% at 1 year and 2.2% at 3 years.

“When initiating opioids, caution should be exercised when prescribing >1 week of opioids or when authorizing a refill or a second opioid prescription because these actions approximately double the chances of use 1 year later. In addition, prescribers should discuss the long-term plan for pain management with patients for whom they are prescribing either Schedule II long-acting opioids or tramadol,” the researchers concluded.

—Melissa Weiss

Reference:

Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017;66:265–269. doi:http://dx.doi.org/10.15585/mmwr.mm6610a1.