A recent study conducted by researchers at Oregon Health and Science University and published in the Journal of General Internal Medicine has outlined some guidelines for physicians and pharmacists in order to reduce the likelihood of opioid dependence in patients being prescribed opioids.
The study was led by Richard Deyo of Oregon Health and Science University, and its purpose was to shed light on how much and for how long opioid medication can be prescribed before a patient inadvertently becomes a long-term user. Their research was centered around the U.S. state of Oregon, as Oregon was the state with the highest rate of non-medical opioid users according to a 2012 survey. Researchers studied data from Oregon's prescription monitoring program, which contains information on 3.6 million opioid prescriptions filled for 874,765 patients. Of these patients, 536,767 of them (61.4 percent) were opiate-naïve, meaning they were first-time users who had no developed tolerance to opioids. The researchers observed that of that first-time user group, 26,785 patients (5.0 percent) became long-term opioid users who received six or more opioid fills within one year. Researchers also observed that long-term opioid use was more common among rural residents than urban residents (6.1 percent versus 4.4 percent respectively), and that the likelihood of long-term opioid use increased with age.
Researchers also paid extra attention to data surround patients who were less than 45 years of age, who did not die within one year of receiving their first opioid prescription. This excluded most cancer and palliative care patients, leaving a remaining 243,427 patients to study. Among these remaining 243,427 patients, just about two percent ultimately become long-term opioid users.
Researchers were able to determine that the likelihood of long-term opioid use increased by about 2.25 percent when patients received two prescription fills versus just one. They also determined that the likelihood was 2.96 percent higher among patients who received higher doses initially—between 400 and 799 cumulative morphine milligram equivalent dosages within 30 days. Long-acting opioids were also more likely to lead to long-term use than short-acting opioids.
Deyo and his researchers noted that these data can be used to help physicians and pharmacists reduce the likelihood of opioid dependency in patients. They suggested that risk of long-term use can be minimized by starting a patient with only a single prescription of a short-acting opioid. Deyo added, “Our data suggest the value of attention to high-risk prescribing, over which clinicians have greater control.”