Each Day of Opioid Use Determines Likelihood of Future Misuse

Important research from the CDC recently published contains valuable information serving to facilitate answers in regard to the relationship between initial prescriptions in patients and how those prescriptions pertain to long-term opioid use (and the likely and eventual misuse). An early prescription given to participants unfamiliar with opioids was found to be associated with the likelihood of long-term and chronic use of the painkillers studied. Though this might seem obvious to many of us, up until this report many of the specifics regarding these associations were largely still hypothesized and were lacking empirical evidence needed to guide prescribing patterns. Basically, there was just a lot left to be learned.

The short and quick of what this report revealed was this:

  • In a sample of individuals unfamiliar with opioids that received a prescription of an opioid-based pain reliever, researchers observed that the likelihood of the initial opioid use becoming prolonged (or chronic), increased with each additional day that the medication was provided to the patient beginning on the third day.
  • The above increase (of early painkiller use leading to an eventual long-term use) was highest on the fifth and thirty-first days. These periods correlated with a second prescription or refill (that is, a prescription or refill of the initial painkiller prescription).
  • The highest probability of long-term, chronic opioid use (observed at durations of both one and three years) was seen in individuals that maintained active prescriptions to long-acting opioids (the second highest probability was found in those regularly prescribed the prescription painkiller tramadol).

Naturally, this data is only valuable if something is done with it. That being said, the study also included some important implications for prescribers and pharmacists as they conduct their duties moving forward:

  • The data provides deterring knowledge that an authorization for a second prescription is likely to double the risk of opioid use in the following year.
  • It challenges clinicians to re-evaluate (on a daily basis) their prescribing decisions and adjust accordingly.
  • It encourages increased discussions between prescribers and patients regarding long-term opioid use, especially in the early stages of the initial prescriptions. This aims to allow goals and timelines to be set by both clients and prescribers, and a re-evaluation to occur that’s more likely to identify warning signs of future misuse.

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