An initial prescription of opioids for 4 to 7 days for the management of acute pain in the primary care setting was found to be sufficient, according to a study published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

The data from a 2014 large US commercial insurer of 13,440 patients who filled an opioid prescription within 7 days of an initial primary care clinic visit were examined. Opioid analgesics were prescribed for back pain with radiculopathy, back pain without radiculopathy, neck pain, joint pain, tendon/bursal pain, muscle strains/sprains, musculoskeletal injury (eg, ligamentous tears), urinary calculus, headache, and/or dental pain. In this cohort, the median initial opioid duration ranged from 4 to 7 days, and the median initial amount of opioids prescribed was 20 to 30 capsules or tablets and 100 to 155 morphine milligram equivalents.

A total of 2392 patients (17.8%) who were prescribed an opioid obtained ≥1 refill within 30 days of the initial prescription. Refill rates were higher for men compared with women (19.3% vs 15.8%, respectively). Patients with a recent history of benzodiazepine (26.5%), sedative hypnotics (20.0%), or gabapentin (28.3%) use had a higher rate of opioid refills within 30 days of initial prescription compared with the overall refill rate (17.8%). Increases in initial opioid prescriptions were associated with decreasing refill rates in the adjusted analysis, specifically for back pain with radiculopathy, nephrolithiasis, and dental pain. The adjusted probability of refill for an initial opioid prescription of 7 days ranged from 0.11 (95% CI, 0.09-0.14) to 0.41 (95% CI, 0.19-0.68) for headache and musculoskeletal injury, respectively.

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Study limitations include a lack of adjustment for associations between patient characteristics and opioid refills.

“The findings in this report suggest that for several acute pain conditions evaluated in primary care settings, opioid analgesics, when provided to treat pain, can generally be prescribed for durations of ≤7 days. However, health systems must anticipate variation in patient, condition, and other contextual characteristics that will influence the duration and intensity of pain and adopt mechanisms to ensure that additional access to both pharmacologic and nonpharmacologic therapy is available when required,” noted the study authors.

Reference

Mundkur ML, Franklin JM, Abdia Y, et al. Days’ supply of initial opioid analgesic prescriptions and additional fills for acute pain conditions treated in the primary care setting – United States, 2014. Morb Mortal Wkly Rep. 2019;68(6):140-143.