Opioid-Naïve Patients Should Be Given Low Doses, No Refills

It’s no secret that prescription drug misuse and abuse are on the rise. In an effort to curb addiction, researchers aimed to find how physician prescribing patterns influence the number of new cases.

The Centers for Disease Control and Prevention (CDC) reported that most opioid overdoses from 1999 to 2014 were in people ages 25 to 54. The top three most common medications involved in overdose deaths were methadone, oxycodone (OxyContin), and hydrocodone (Vicodin). In this new analysis, published in the Journal of General Internal Medicine, the researchers focused on deaths in the state of Oregon — which had the most non-medical opioid users in 2012.

Using 3.6 million opioid prescriptions filled for 874,765 people, the team identified 536,767 patients (61.4%) who were opioid-naïve. Of these, 26,785 patients (5%) who had received six or more prescription fills in a year became long-term opioid users. The findings revealed that the patients who received two prescription fills, compared to one, had a 2.25 higher risk of becoming a long-term opioid user.

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Increased age was associated with a greater likelihood of becoming a long-term user. Further analysis looked at the 243,427 patients under the age of 45. Out of the people who only had one prescription fill, only 2% became long-term users.

“The increasing risk of long-term use even at low cumulative doses supports the Centers for Disease Control recommendation of limiting therapy to three to seven days for most patients,” lead author Richard Deyo, MD, MPH, from Oregon Health and Science University, said in a news release.

Dosage also played a part in long-term opioid risk. Those who were first given between 400 and 799 cumulative morphine milligram equivalent dosages within 30 days, compared to lower doses, had a 2.96 higher risk of becoming a long-term user.

In addition, long-acting opioids had a higher risk for long-term use than short-acting medications.

The researchers explained that to minimize long-term use risk in new patients, they should be prescribed a single prescription of short-acting opioids (cumulative dose of less than 120 morphine equivalents) with no refills.

“Our data suggest the value of attention to high-risk prescribing, over which clinicians have greater control. This in part reflects concern that we are dealing with risky drugs, not risky patients,” Deyo concluded.

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