Preventing Opioid Dependency With Low Initial Dose, No Refills
The risk of long-term opioid use can be reduced by prescribing a short-acting painkiller with no refills.
HealthDay News -- Patients who are first-time users of opioids should be prescribed a small dose without refills, in order to reduce the risk of long-term use and possible addiction, according to a study published online on August 2, 2016 in the Journal of General Internal Medicine.1
Researchers analyzed data from 536 767 patients in Oregon who were prescribed opioids for the first time. The investigators found that 5.0% of those who received 6 or more refills within a year became long-term users. This trend was higher among rural patients (6.1%) than among urban patients (4.4%, P <.001). And the risk of long-term use increased with age (P <.001).
Further study of data from 243 427 patients aged 45 and younger found that those who were given 2 prescription fills were 2.25 times more likely to become long-term opioid users than those who received 1 prescription. The risk was also greater among patients who got higher initial doses and long-acting rather than short-acting medications.
The risk of long-term use can be reduced by prescribing a short-acting painkiller with no refills, according to study leader Richard Deyo, MD, MPH, a professor of evidence-based medicine at the Oregon Health & Science University in Portland.
"The increasing risk of long-term use even at low cumulative doses supports the U.S. Centers for Disease Control and Prevention's recommendation of limiting therapy to 3 to 7 for most patients," Deyo said in a journal news release. "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, R.A., Hallvik, S.E., Hildebran, C. et al. J Gen Intern Med (2016). doi:10.1007/s11606-016-3810-3.