Lower Doses and No Refills Can Curb Long-Term Opioid Use

When doctors order an opioid for a patient for the first time, they should prescribe a short-acting one without fills to reduce the chances of long-term use or addiction.

That’s the conclusion of a new study out of Oregon that examined prescription data from more than 500,000 patients in the state who were considered opioid-naïve, meaning they had never been given an opioid before a physician prescribed one.

About 5% of these patients became long-term opioid users, meaning they received 6 or more refills of an opioid medication within a year, the researchers reported in the Journal of Internal Medicine. Rural residents were more likely than urban ones (6.1% vs. 4.4%) to be long-term users, and older people were more likely to engage in long-term use.

Researchers then looked at patients who were younger than 45 who did not die within a year of receiving their first opioid prescription. This eliminated most cancer and palliative care patients, but left around 243,000 patients. Of those who had a single prescription fill, only 2% became long-term opioid users. But the odds were 2.5 times higher for patients who received 2 fills as opposed to 1.

Also, patients receiving initial doses of between 400 and 799 cumulative morphine milligram equivalent dosages within 30 days were nearly 3 times more likely to become long-term users compared to those on lower doses.

“The increasing risk of long-term use even at low cumulative doses supports the Centers for Disease Control recommendation of limiting therapy to 3 to 7 days for most patients,” Richard A. Deyo, MD, MPH, a professor of evidence-based medicine at Oregon Health and Science University, said in a statement.


Jonathan Block

Jonathan Block

Jonathan Block is a freelance writer and former MedShadow content editor. He has been an editor and writer for multiple pharmaceutical, health and medical publications, including BioCentury, The Pink Sheet, Modern Healthcare, Health Plan Week and Psychiatry Advisor. He holds a BA from Tufts University and is earning an MPH with a focus on health policy from the CUNY Graduate School of Public Health & Health Policy.


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