Risk of long-term opioid use and its sequelae due to opioid prescribing for acute pain

Risk of long-term opioid use and its sequelae due to opioid prescribing for acute pain

PI: Julie Donohue, PhD
Funding Source: Benter Foundation
2018 - 2020

A large-scale study of patient records has revealed opportunities for physicians to curb opioid prescribing with the goal to reduce future risk of patients developing opioid use disorder. The study, supported by the Benter Foundation, focused on estimating the relative risk of long-term opioid use and its consequences (opioid use disorder and overdose) among patients drawn from four groups experiencing acute pain. The study was one of the first to examine the role of pain severity on opioid prescribing for a range of conditions using electronic health record data from multiple health systems linked with health insurance claims data.

Groups evaluated included adolescents and adults presenting with pain in the emergency room for common pain-related diagnoses, adolescents and young adults visiting the primary care setting for acute pain, adults undergoing low-risk surgical procedures, and women discharged after having non-complicated vaginal deliveries.  Results of the project point to cohort-specific interventions that may be used to prevent long-term opioid use.

Adolescents prescribed opioids have more than double the risk of opioid use disorder and nearly six times the risk of overdose, according to the report’s findings. Potential interventions suggested by the research team include updating treatment guidelines, providing continuing medical education on risks of opioid prescribing to adolescents, and offering routine screening for substance use disorders.

The investigators also found that opioid prescribing was unrelated to the degree of pain for low-risk surgery and for non-complicated vaginal deliveries. Furthermore, women with non-complicated deliveries who filled an opioid prescription after being discharged from the hospital had more than double the risk of opioid use disorder compared with those who didn’t fill a prescription. These findings suggest that changes could be made in the default discharge medication orders to avoid opioid prescribing in settings where patients were not experiencing acute pain post-surgery, and that opioid prescribing to women after uncomplicated vaginal births should be closely monitored.

Another important finding made by the research team was that risks of continued opioid use up to a year later were 1.5 to 5.5 times higher in certain groups who filled an opioid prescription within three days of an acute pain encounter compared to those who didn’t fill a prescription. Updating prescribing guidelines to screen for risk of long-term opioid use and the creation of opioid personalized prescribing report cards might be helpful in reducing the risk of long-term opioid use in these patients.