The initial prescription amount and days' worth of pills can have a big impact on the long-term use of opioids, according to a new study.
Conducted by the Tennessee Department of Health and published in JAMA Network Open, researchers examined the risk factors associated with long-term opioid use for people who, prior to a work injury, were opioid-free.
Findings linked 4% of these injured workers to long-term opioid use. All of these long-term users received 20 or more days’ worth of supply in the initial prescription and had visited three or more prescribers.
The study examined the files of 46,000 injured workers in Tennessee who were not taking opioids at the time of their injury. All of the surveyed people were receiving workers' compensation from the state between March 2013 and December 2015. Information was also taken from Tennessee’s prescription drug monitoring program.
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By law, opioid dispensing in Tennessee is limited to a 30-day supply, and a 60-day restriction allows for only two consecutive periods of 30-day prescriptions.
The study examined six opioid-use characteristics: days’ supply of first prescription, receipt of a long-acting opioid within 30 days of injury, overlapping opioid and benzodiazepine prescription, the number of prescribers and pharmacies visited within 90 days of injury and the maximum dosage received within 30 days of the injury.
Overall, 4% of those who received opioids began long-term use, and 1.7% sustained use up to 90 days after an injury.
In addition, the number of injured workers who received an opioid on the days after the injury decreased sharply from 1834 to 966 people between the first and second month and decreased between 31 and 120 days after injury. The number plateaued after 120 days.
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“Although previous studies have identified risk factors for the development of long-term opioid use, this appears to be the first to comprehensively measure all opioid prescriptions, regardless of insurance type, opioid dependence or substance use disorder diagnosis, for long-term use in injured workers,” the study concluded. “In this predictive model, prescribing practices appear to be more associated with opioid use than demographic characteristics. Unlike patient demographic characteristics, prescribing may be modified to reduce patient risk.”