An updated view on the influence of initial opioid prescription characteristics on long-term opioid use among opioid naïve patients

Objectives

This retrospective cohort study provides an updated view on the association between the likelihood of long-term opioid use (LTOU) and characteristics of the initial opioid prescription (dose, opioid type) and initial opioid prescription episode (days’ supplied) among opioid-naïve patients utilizing IQVIA PharMetrics®Plus for Academics database representative of commercially insured patients in the US.

Methods

Kaplan-Meier estimates were used to determine opioid continuation likelihood at 365 days stratified by the characteristics of the initial opioid prescription and initial opioid prescription episode. Cox-proportional hazard models were estimated to determine the strength of association between initial opioid prescription characteristics and opioid continuation.

Results

A total of 578,403 cancer-free, SUD-free, opioid-naïve subjects aged ≥14 years that filled ≥1 opioid prescriptions between April 13, 2016 and April 18, 2020 were identified and categorized based on time to opioid discontinuation. After accounting for censoring, 5.05 % of persons continued opioid use for ≥365 days. Compared to a 1–2 days’ supply (DS), the likelihood of opioid discontinuation was consistently lower with higher DS [HRs (CIs): 3–4 days' supply = 0.66 (0.65–0.66); 5–7 DS = 0.41 (0.41–0.41); 8–10 DS = 0.33 (0.33–0.34); 11–14 DS = 0.30 (0.29–0.31); 15–21 DS = 0.26 (0.26–0.27); ≥22 DS = 0.17 (0.17–0.18)]. These associations between increased DS and decreased likelihood of discontinuing opioid remained consistent across different pain etiologies.

Conclusions

In this era of more conservative opioid prescribing, increases in DS remains the strongest factor associated with a higher likelihood of LTOU.