About one in seven people prescribed a short course of narcotic pain relievers will still be taking the drugs a year later, according to a new study that sheds more light on the risks of treating acute pain with opioids.
The research, published by the Centers for Disease Control and Prevention, found that the chances of long-term opioid use increase quickly after just three days. People who receive a one-day prescription have a six percent chance of chronic use. The probability rises to 13.5 percent when the prescription is for a week or more of medication.
And while only 7 percent of prescriptions for acute pain are for 30 days, almost one third of people who receive a month's worth are taking the drugs a year later.
"It's pretty alarming," says Anuj Shah, a PhD candidate at the University of Arkansas College of Pharmacy and co-author of the study. "Just going from one or two days to five days, seven days, your chances of long-term use almost double."
New Hampshire doctors and nurses have ranked among the nation’s most prolific prescribers of addictive painkillers, which contributed to three of every four overdose deaths in the state from 2000-2011. Prescriptions began to decrease after the state adopted a monitoring program in 2014, but many long-term users have transitioned to cheap heroin and fentanyl analogues.
The researchers, who analyzed the records of 1.3 million non-cancer patients who received at least one opioid prescription between June 2006 and September 2015, do not equate long-term use with dependency or addiction. Shah says that was by design: opioid use for chronic conditions can be, and often is, well-managed by patients and their physicians.
"Long-term use is definitely one of the really, really big risk factors for all the problems associated with opioid use, like addiction, dependency and overdose," Shah says.
Shah and his colleagues also found a link between long-term use and the type of opioid prescribed.
Patients who received long-acting or extended-release formulations had a 27 percent chance of still using the drug a year later, and a 20 percent chance of using it three years later. Short-acting versions of hydrocodone and oxycodone, which must be taken several times a day, were associated with a lower probability of continued use after a year - 5.1 percent for hydrocodone and 4.7 percent oxycodone.
The study is timely, coming one year after the CDC released guidelines aimed at cutting down on the number of opioids prescribed. The results reinforce the CDC's recommendation that three days of opioids are enough for most patients with acute pain, and that seven days or more "will rarely be needed."
New Hampshire's new opioid prescribing guidelines took effect in January. The culmination of months of negotiation between lawmakers and physicians, they are less cautious than the CDC's recommendations.
The state's new rules limit emergency rooms and urgent care clinics to no more than a week's prescription, but only advise primary-care and other practitioners to prescribe "the lowest effective dose for the fewest number of days."
Shah’s says, given the lack of evidence that long-term opioid use is effective for pain relief, patients and physicians must proceed with care.
“What this research is trying to show is that when you do initiate opioids it should be done with a lot of caution,” he says, “and a lot of discussion between the physician and patient as to how the therapy should be managed.”