Vulnerability to Opioid Abuse is Highest in the First Days of Opioid Therapy

Opioid abuse has increased sharply over the past few years, with the rate of overdose deaths nearly quadrupling since 1999, according to the Department of Health and Human Services. A large proportion of overdose deaths are related to prescription painkillers. Now, a new report released by the Centers for Disease Control and Prevention (CDC) sheds light on the factors that increase the likelihood of developing an opioid use disorder.

The CDC Report Characterized the Transition from Acute to Chronic Opioid Use

Scientists and public health officials have long speculated about the factors that may be contributing to the ongoing opioid epidemic. One major concern is the overprescribing of prescription drugs. In 2013, medical professionals wrote 249 million prescriptions for opioid painkillers. That’s enough for every adult in the United States to have a bottle of pills.

The recently released CDC report entitled “Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use” may help public health officials better understand what causes some people to develop opioid use disorder. The study provides the best snapshot to date of the transition from acute opioid use to chronic use.

The study included more than 1.2 million American adults receiving an opioid prescription at least once from 2006 to 2015. All participants were opioid naive patients, meaning that this was their first opioid prescription. They had not struggled with substance abuse in the past. The study followed participants from the date they were first prescribed opioids. It also monitored the number of prescriptions and cumulative doses they received. This allowed researchers to track which patients were most likely to continue using opioids over the long term.

Key Findings from the CDC Report

The study identified several factors that predicted long-term opioid use:

1. Patients still using opioids after the fifth day of therapy were much more likely to use opioids long term. They observed a similar spike for people who were still using prescription opioids after one month (31 days).
2. When the supply provided with the first prescription was high, such as a 10- or 30-day supply, opioid naïve patients were more likely to develop long-term use of opioid pain relievers.
3. Every day of continued use after the third day of therapy was associated with a greater likelihood of using opioids long term.
4. Obtaining a second prescription or receiving a refill significantly increased a person’s risk of continued opioid use.
5. People who were still using opioids after one year or three years were much more likely to have been prescribed a long-acting opioid. Tramadol was the next most significant drug among these long-term opioid users.
6. Individuals who were still using prescription opioids after one year were more likely to be female, older, started on a higher dose of opioids, and have a previous diagnosis of a pain condition.

The CDC Study Illustrates the Need to Update Opioid Prescribing Practices

The CDC report is very informative, as it provides a comprehensive picture of the factors that cause people prescribed opioids for an acute event to continue using the drugs even after a year or longer. The report indicated that among people who used opioids for at least one day, nearly 1 in 17 was still using opioids a year later. This is a serious concern, as long-term use of opioids is associated with opioid addiction. Additionally, it may increase the likelihood that a person tries heroin or other opioids in the future. The results of this CDC study make it clear that we need to change opioid prescribing in the U.S.

First, an initial opioid prescription should not include long-acting drugs or a large supply of medications. Most people prescribed opioids for non-cancer pain only need the drugs during the acute phase of their illness or surgical recovery. Thus, a 3- to 5-day supply may be sufficient. Whereas, a 10- or 30-day supply may encourage people to continue taking potentially addictive drugs for longer than necessary.

It is also important for physicians to educate patients about non-opioid methods of pain management. This may include other, non-addictive medications that are appropriate for managing inflammation and non-severe pain. Additionally, people with chronic pain should be encouraged to explore non-pharmaceutical options rather than receiving a prescription for opioid painkillers. Exercise therapy, cognitive behavioral therapy, and other interventional treatments can help these people manage pain in a safer manner.

Finally, we must focus our efforts on helping those who have developed an opioid use disorder get help. Treatments such as medical detox can help individuals suffering from opioid dependence cleanse the opioids from their bodies, providing a safe, compassionate treatment for these vulnerable people.

Sources
The Opioid Epidemic: By the Numbers, HHS.
CDC Guideline For Prescribing Opioids For Chronic Pain, CDC.
CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016, CDC.