Duration of opioid prescription, not dosage, strongest predictor of postsurgical opioid abuse — 5 key insights

According to a study in the BMJ, duration of opioid prescription rather than dosage is more strongly associated with abuse among surgery patients without a history of recent or chronic opioid use.

Here are five things you need to know:

1. The retrospective cohort study analyzed surgical claims from a linked medical and pharmacy administrative database of more than 37 million commercially insured patients between 2008 and 2016. During this time more than 1 million patients without a history of opioid use underwent surgery.

2. Dosage was defined as the amount of medication a patient takes over 24 hours. Developing dependence, showing symptoms of abuse or experiencing nonfatal overdose were categorized as opioid misuse.

3. A code for abuse was identified for 5,906 patients, or 0.6 percent of patients; 568,612 patients— 56 percent — received postoperative opioids. Total duration of opioid use was the strongest predictor of misuse, with each refill and additional week of opioid use associated with an adjusted increase in the rate of misuse of 44 percent or 20 percent increase for every week of prescription.

4. Although the rates of misuse in the study were low, many surgeries are performed each year on patients who are then prescribed opioid medications.

5. Current opioid pain management guidelines do not focus on specific patient populations.

"We are in the midst of an epidemic, and physician prescription practices play no small part in it," said senior investigator Nathan Palmer, PhD, a biomedical informatics researcher at Harvard Medical School in Boston. "Understanding differences in risk for opioid misuse across various patient populations and clinical contexts is critical in informing the creation of narrowly tailored guidelines, clinical decision making and the national conversation on this topic."

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