Currently, guidelines state that opioid therapy at a morphine equivalent dose of 100 mg or more puts patients at a higher risk of overdose and adverse events. However, long-term use, even at a lower dose, may present a similar risk. In one recent study, Turner and colleagues examined whether the total amount of opioid prescribed over a period of time was related to serious complications such as drug overdose.4

“In an analysis of over 200,000 patients who filled at least two prescriptions for stronger types of opioids, we found that those on a very high dose – a morphine equivalent dose of 100 mg or more – had three times greater risk of drug overdose than people who were not taking these drugs,” Turner said. “However, we also found that a patient receiving a lower daily dose of 50 to 99 mg, but for whom the total morphine equivalent dose prescribed was more than 1830 mg over a six-month period, put the patient at the same risk of drug overdose as someone taking a [much] higher dose.”

These results support efforts not only to keep opioid dosing low but also to shorten the duration of treatment. However, the study was limited by a small sample size and incomplete information on compliance and use of other medications.

Conclusion

Overall, there is no question that physicians need to reduce their reliance on opioids as the main approach to managing pain. “The problem is that patients get stuck in a rut with these medications, in part because they come to believe that opioids offer their only life line to reducing pain,” Turner said. “Opioids generally do not fix the cause of pain. Rather, they treat the symptom of pain. We physicians need to help patients realize there are other options to manage pain.”

Medically reviewed by Pat F. Bass III, MD, MS, MPH  

References

1. Ekholm O, et al. Pain. 2014; 155: 2486-2490.

2. Guideline for the Use of Chronic Opioid Therapy in Chronic Non-Cancer Pain. American Pain Society. Available at: . Accessed: Feb. 1, 2015.

3. Brejvik H, et al. Pain. 2014; 155: 2441-2443.

4. Liang Y and Turner B. J Pain. 2015; Article in Press.