Low Back Pain: First-Line Opioids Increase Risk for Long-term Use

New data suggests a decline in emergency room opioid prescribing rates.

Early receipt of opioids for acute occupational low back pain (AOLBP) in the emergency department (ED) is linked to an increased risk for long-term use and higher medical costs, according to a retrospective cohort study published online in the Journal of Emergency Medicine.1

In line with other recent studies,2  the findings also indicated increased clinical adherence to guidelines intended to limit first-line use of opioids for AOLBP.

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Led by Sharon S. Lee, MD, MPH, researchers from the Liberty Mutual Research Center for Safety in Hopkinton, Massachusetts, analyzed workers’ compensation claims from a nationally representative sample of 2887 patients who had received an opioid prescription within 2 days of presenting to the ED with uncomplicated AOLBP.

After adjusting for injury severity, early MRI, age, sex, and job tenure, they found that early opioid use was linked to a nearly 30% increased risk for long-term use (risk ratio = 1.29; 95% confidence interval [CI], 1.05 – 1.58), as defined by ≥3 additional opioid prescriptions filled over a 12-month follow-up.

Compared with no opioid use, the highest dosage quartile was also linked to a significant increase in total medical cost of $7385 (95% CI $2,382 – $12,388) per case.

The study is the first to examine ED treatment for AOLBP using a 3-day prescribing timeframe from symptom onset, contrasting with prior studies that evaluated opioid use within 15 days3 and 6 weeks.4

According to the authors, the narrower timeline was selected based on evidence that over 50% of AOLBP patients with early opioid use obtain the prescription during their first medical visit, which often occurs in the ED.

“I’ve sometimes heard people say that no one will get addicted from a few days of opioids prescribed in the ED, but this study shows that early opioid prescribing in the ED for uncomplicated AOLBP is in fact associated with higher long-term opioid use,” Daniel del Portal, MD, from the department of emergency medicine at Temple University Hospital in Philadelphia, PA, told Clinical Pain Advisor