Higher Dose and Duration of Initial Opioid Prescriptions Associated With Long-term Opioid Use

Prescribing opioid medications, even when intended for short-term use, can lead to long-term opioid use (LTOU), which is a risk factor for use disorders and overdose. As a result, guidelines recommend limiting the prescribing of opioids and the dose and days supplied for initial opioid prescriptions. Researchers used a commercial pharmacy database to investigate the association between initial opioid prescription characteristics and LTOU. They included individuals >14 years old who were prescribed an opioid analgesic between 2016 and 2020 and had not received one in the 180 days before that; they excluded those with a cancer or substance use disorder diagnosis. LTOU was defined as ≥365 days of continued opioid use after the initial prescription.

• A total of 578,403 individuals in the database met criteria for this study; 4186 (0.7 percent) had subsequent LTOU; after excluding those who were not followed for ≥365 days, the estimated likelihood of LTOU was 5 percent.
• In adjusted analysis, the probability of LTOU increased with the duration and cumulative daily dose of the initial opioid prescription. Compared with an initial opioid prescription of a 1–2 day supply, receipt of a 3–4 day supply decreased the likelihood of discontinuation by >30 percent; a ≥22 day supply decreased it by >80 percent.

Comments: A substantial proportion of individuals who receive an initial opioid prescription continue taking opioids for a year or more after. These findings support recommendations to limit opioid prescribing in general, and to limit the dose and duration when prescribing.

Darius A. Rastegar, MD

Reference: Smith AM, Shah A, Martin BC. An updated view on the influence of initial opioid prescription characteristics on long-term opioid use among opioid naïve patients. Drug Alcohol Depend. 2024;265:112463.