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Summary What is already known about this topic? Based on the CDC Guideline for Prescribing Opioids for Chronic Pain, literature supporting long-term opioid therapy for pain is limited; research suggests an increased risk for harms with long-term opioid use.
What is added by this report? The highest probability of continued opioid use at 1 and 3 years was observed among patients who started on a long-acting opioid followed by patients who started on tramadol. What are the implications for public health practice? Awareness among prescribers, pharmacists, and persons managing pharmacy benefits that authorization of a second opioid prescription doubles the risk Work term report opioid use 1 year later might deter overprescribing of opioids.
Knowledge that the risks for chronic opioid use increase with each additional day supplied might help clinicians evaluate their initial opioid prescribing decisions and potentially reduce the risk for long-term opioid use.
Discussions with patients about the long-term use of opioids to manage pain should occur early in the opioid prescribing process.
Because long-term opioid use often begins with treatment of acute pain 1in Marchthe 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 2.
However, data quantifying the transition from acute to chronic opioid use are lacking. The largest increments in probability of continued use were observed after the fifth and thirty-first days on therapy; the second prescription; morphine milligram equivalents cumulative dose; and first prescriptions with and day supplies.
By providing quantitative evidence on risk for long-term use based on initial prescribing characteristics, these findings might inform opioid prescribing practices. Patients excluded were those who had any cancer other than nonmelanoma skin cancer or a substance abuse disorder diagnosis in the 6 months preceding their first opioid prescription, or whose first prescription was for any buprenorphine formulation indicated for treatment of substance abuse.
The first opioid prescription was categorized into six mutually exclusive categories: A total of 1, patients met the inclusion criteria, including 33, 2.
Among persons prescribed at least 1 day of opioids, the probability of continued opioid use at 1 year was 6. Substantial increases in probabilities of continued opioid use occurred when the initial duration reached 6 and 31 days supplemental figure 2; https: The highest probabilities of continued opioid use at 1 and 3 years were observed among patients who initiated treatment with a long-acting opioid The probabilities of continued opioid use at 1 and 3 years for persons starting on hydrocodone short acting 5.
Top Discussion The probability of long-term opioid use increases most sharply in the first days of therapy, particularly after 5 days or 1 month of opioids have been prescribed, and levels off after approximately 12 weeks of therapy. The rate of long-term use was relatively low 6.
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.
As expected, patients initiated on long-acting opioids had the highest probabilities of long-term use. Long-term data on tramadol for pain management are sparse, with only one trial exceeding 12 weeks in duration 6. A study in Oregon 7which did not include tramadol a predictor of long-term use according to current datareported similar findings: However, that analysis only examined opioid use in the first month after initiation of opioid therapy to characterize risks for long-term use and did not account for the actual duration of therapy.
The findings in this report are subject to at least five limitations. First, although the cumulative dose of the first episode of opioid use is described, the likelihood of long-term use when the prescriber was titrating the dose was not determined.
Rather, the total cumulative dose was calculated, which might have been increasing or decreasing over time.
Second, the extent to which chronic opioid use was intentional versus the outgrowth of acute use is not known. Third, information on pain intensity or duration were not available, and the etiology of pain, which might influence the duration of opioid use, was not considered in the analysis.
Finally, prescriptions that were either paid for out-of-pocket or obtained illicitly were not included in the analysis. Transitions from acute to long-term therapy can begin to occur quickly: Consistent with CDC guidelines, treatment of acute pain with opioids should be for the shortest durations possible.
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.PEOPLE OFTEN ASK GALLUP, "Are millennials really that different?" The answer is yes ― profoundly so.
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