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Prescription Risk Factors
One Quarter of Opioid Patients Become Long-Term Users
A history of substance abuse, a greater burden of illness, and smoking may drive a progression from shorter to longer term opioid use. The Mayo Clinic found those were among the strongest risk factors leading to episodic or long-term opioid use.
Researchers looked at a sample of patients in an area near the Minnesota-based clinic who received prescriptions for opioids during 2009. The patients’ opioid uses were categorized into the following time frames:
- Short term — episodes of opioid prescribing that lasted 90 days or less.
- Episodic — episodes of opioid prescribing lasting longer than 90 days if the total days supply was less than 120 and the total number of prescriptions was fewer than 10.
- Long term — episodes of opioid prescribing lasting longer than 90 days with 120 or more total days supply or 10 or more prescriptions.
“Overall, 293 patients received 515 new opioid prescriptions in 2009,” the authors noted. “Of these, 61 (21 percent) progressed to an episodic prescribing pattern and 19 (6 percent) progressed to a long-term prescribing pattern.”
Prescriptions included in the study sample were all those in the opioid analgesic drug class: all formulations of oxycodone, morphine, hydromorphone, oxymorphone, hydrocodone, fentanyl, meperidine, codeine, and methadone. The most common reason for the first prescription was surgery or another painful procedure, followed by musculoskeletal pain and trauma.
For each of the three prescribing patterns, the authors looked at characteristics such as education, the presence of depression or anxiety, additional psychiatric illness, substance abuse, nicotine use, and CCI — severity and age weighted sum of diseases.
“In univariate models, patients in the group who received the episodic prescribing pattern were more likely to be past or current nicotine users than were patients in the group who received the short-term prescribing pattern. Patients in the group with the long-term prescribing pattern were more likely to have lower education levels, a past or current history of nicotine use, a past or current history of substance abuse, and a higher CCI than were patients in the group who received the short-term prescribing pattern,” the report explained. “When those in the episodic and long-term groups (i.e., who received more than 90 days of prescriptions) were considered together and compared with those in the short-term group, the former were more likely to have a past or current history of nicotine use, other psychiatric diagnosis, and a past or current history of substance abuse.”
The authors found that smokers with chronic pain were more likely to use opioids and in greater quantities than nonsmokers with chronic pain. They said research suggests an interaction between the pharmacology of nicotine and opioids.
“A reciprocal relationship has been observed between opioid and nicotine consumption,” they explained. “Increases in opioid use have been associated with increases in nicotine use, and increases in nicotine use have been associated with increases in opioid consumption.”
Medical providers should screen patients for past or current tobacco use and past or current substance abuse before starting an opioid prescription, the authors advised. “This would allow the clinician to assess the risk of longer-term prescribing and would provide the opportunity to counsel the patient about these potential risk factors before actually receiving the initial prescription.
