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Day-Supply of Opioids Most Decisive Factor in Long-Term Use

The single biggest factor determining whether a patient is likely to use opioids long term may be the number of days' supply initially prescribed, according to a study by University of Arkansas for Medical Sciences (UAMS) researchers.

"Compared to someone prescribed two days vs seven days, that person with a seven-day supply is twice as likely to be using opioids in the long term," says Bradley Martin, PharmD, PhD, senior author of the study, and a professor in the division of pharmaceutical evaluation and policy in the UAMS College of Pharmacy's department of pharmacy practice. "The days supplied is far more important than the dosage level or even the type of pain being treated."

The study was recently published online in The Journal of Pain by Martin and UAMS researchers Anuj Shah, a PhD student in the division of pharmaceutical evaluation and policy and a fellow at the Arkansas Center for Health Improvement, and Corey Hayes, PharmD, a postdoctoral fellow in the UAMS College of Medicine's department of psychiatry.

They looked at people previously prescribed opioids who had not used one in six months, the number of days on an opioid prescription they initially received, and whether they were still using opioids one year later.

Their most recent study is a follow-up to one by Martin, Shah, and Hayes published in March in the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report that more broadly examined the effect of the day-supply of opioids on long-term use.

The study used 1.3 million patient records from 2006 to 2015 that were drawn from the IMS Lifelink+ database, which includes commercial health plan information and deidentified information on the enrollees.

In the follow-up study, Martin, Shah, and Hayes examined the likelihood of long-term use of opioids among patients who received opioids for chronic pain, surgery, trauma, and other pain conditions.

"In our previous study, we looked at anyone who was prescribed an opioid for any reason," Martin says. "Now, people with chronic pain compared to people who just had surgery are about 25% more likely to continue using opioids. Clearly, people with chronic pain are more likely to be long-term opioid users. The type of pain does matter, but before doing the study we thought chronic pain vs surgical pain would be a stronger predictor of long-term use."

The vast majority of people with an initial episode of opioid use discontinue opioids, the study shows. On average, more than 80% of chronic pain patients discontinue in less than a year, and 90% with nonchronic pain discontinue in less than a year.

While there is no clear and specific point of transition to chronic use, the longer the duration an initial opioid prescription lasts, the higher the chances opioid use will continue months or even years later, according to the study.

"Comparing someone who has a one- or two-day supply of opioids with someone who has a week's supply, the risk of use doubles," Martin says. "This is something clinicians can easily modify when they prescribe opioids."

Source: University of Arkansas for Medical Sciences