March 27, 2017 | By prescribing for a patient an opioid supply of three days or less, a health care professional can reduce the likelihood of a patient’s chronic opioid use one to three years later, according to University of Arkansas for Medical Sciences (UAMS) research.
In a report published online March 17 in the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, UAMS researchers Bradley Martin, Pharm.D., Ph.D., Anuj Shah, a Ph.D. student, and Corey Hayes, Pharm.D., looked at people previously prescribed opioids who had not used one in six months, the number of days on an opioid prescription they received and whether they were still using opioids one and three years later.
The UAMS-funded study used 1.2 million patient records from 2006-2015 that were drawn from the IMS Lifelink+ database, which includes commercial health plan information and insurees. Any identifying information was removed from the records before the researchers analyzed them.
Among the researchers’ findings were that the likelihood of chronic opioid use increases with each additional day of medication supplied, starting on the third day, and increases the sharpest after the sixth and 31st days on opioid therapy or when a second prescription was authorized or refilled.
“A person who receives just an 11-day supply of their first opioid, their probability of them still being a user one year later is 25 percent,” Martin said. “I don’t think clinicians realize how likely that is. There’s a very significant risk that rises quickly in a short period of time.”
Individuals starting on a long-acting opioid such as oxycontin or morphine sulfate, or a commonly prescribed opioid like tramadol, were more likely to remain on opioids than persons prescribed hydrocodone or oxycodone. The data show that prescribing three days or fewer of opioids can reduce the chances of long-term opioid use.
Martin, the senior author of the study, is a professor and head of the Division of Pharmaceutical Evaluation and Policy in the UAMS College of Pharmacy’s Department of Pharmacy Practice. Shah, a co-author with Martin and Hayes, is a Ph.D. student in the division and a fellow at the Arkansas Center for Health Improvement, and Hayes is a postdoctoral fellow in the UAMS College of Medicine’s Department of Psychiatry.
In March 2016, the Centers for Disease Control and Prevention issued a recommendation for prescribing less than a week’s supply of opioids for acute pain and for selecting what type of opioid to prescribe when therapy is started.
“We wanted to corroborate that,” Martin said. “In earlier research, we had looked at how long it takes a chronic user of opioids to discontinue use. Entering into this research, we were wondering at what point does someone becomes a chronic user. No one had looked at when that happens. When does the transition happen between short-term to long-term use?”
Martin said while there is no clear and specific point of transition to chronic use, the longer the duration of periods of even early opioid use can lead to an increased risk of chronic use months or even years later.