POST Online Media Lite Edition


NEWLY REPORTED COVID-19 CASES IN LAST 24 HOURS (9.21.2021, 5:41pam CEST, WHO):   India 26,115    Brazil 9,458    United Kingdom 35,702    Russia 19,179    Turkey 27,688    Iran 17,397    Columbia 1,813    Italy 2,405    Indonesia 3,263    Germany 4,664    Mexico 4,983    South Africa 1,504    Philippines 18,937    Ukraine 5,159    Malaysia 14,345    Netherlands 1,370    Iraq 3,192    Japan 2,405    Bangladesh 1,562    Thailand 10,919    Pakistan 2,167    Romania 6,789    Morocco 2,246    Serbia 6,424    Jordan 1,075    Cuba 8,544    Nepal 1,036    Austria 1,162    Vietnam 8,681    Greece 2,124    Georgia 2,470    Belarus 1,941    Costa Rica 1,627    Bulgaria 2,360    Myanmar 1,687    Palestine 3,909    Croatia 1,037    Ireland 1,150    Libya 1,081    Lithuania 1,157    South Korea 1,729    Mongolia 2,543    Botswana 1,536    El Salvador 2,323    China 83    Singapore 0    New Zealand 15    Australia 1,515   

Preventing dependency when patients first receive opioids

Staff Writer |
Clinicians should think twice when prescribing opioid medication to patients for the first time to relieve pain, migraines or severe coughs.

Article continues below

To prevent possible addiction, doctors and pharmacists should err on the side of caution when considering dosages or subsequent refills. This was highlighted in a study led by Richard Deyo of Oregon Health and Science University in the U.S.

A substantial increase in opioid prescriptions over the past two decades in the US has gone hand-in-hand with a significant rise in overdoses and addiction treatment.

These trends have prompted calls for the more selective use of opioids for medical reasons.

Deyo's team wanted to shed light on how much and for how long opioids can be prescribed for the first time to so-called opioid-naïve patients without their inadvertently becoming long-term users.

They focused their attention on Oregon, the U.S. state with the highest rate of non-medical opioid users in a 2012 survey. One year's data was obtained from Oregon's prescription monitoring program about outpatient prescriptions filled for controlled substances, including opioids, at all non-state or non-federal retail pharmacies.

Data from Oregon vital records and a statewide hospital discharge registry were also included. Deyo's team began with data from 3.6 million opioid prescriptions filled for 874,765 patients.

Of these, 536,767 people (61.4 percent of the total study group) were opioid-naïve patients.

After analyzing this first-time user group further, it was found that 26,785 (5.0 percent) became long-term opioid users who received six or more opioid fills within a year.

This trend was higher among rural than urban residents (6.1 percent versus 4.4 percent respectively), while the likelihood of long-term use increased with age.

The researchers then analyzed the information of patients younger than 45 years old who did not die within one year of receiving their first opioid prescription.

This excluded most cancer or palliative care patients, but still left the research team with 243,427 patients. Among those with a single prescription fill, just two percent became long-term opioid users.

The odds ratio of becoming a long-term opioid user was 2.25 higher among patients who received two prescription fills compared to one.

It was also 2.96 higher for those initially receiving between 400 and 799 cumulative morphine milligram equivalent dosages within 30 days, compared to patients on lower doses. Long-acting opioids were associated with a higher risk than short-acting drugs.

Data from this study show that the risk of long-term use can be minimized by starting off a patient with a single prescription of a short-acting opioid with no refills. Its cumulative dose should be less than 120 morphine equivalents.

"The increasing risk of long-term use even at low cumulative doses supports the Centers for Disease Control recommendation of limiting therapy to three to seven days for most patients," Deyo notes.

"Our data suggest the value of attention to high-risk prescribing, over which clinicians have greater control," he adds. "This in part reflects concern that we are dealing with risky drugs, not risky patients."

What to read next

Many take opioids months after hip, knee replacements
Opioid dependence can start in just a few days
U.S. hospitals vary nearly twofold in opioid prescribing rates