Patients who take long-acting opioids are more likely to experience chronic opioid use, a report published in the CDC’s Morbidity and Mortality Weekly Report has determined. The findings support previous research which found an association between early opioid prescribing patterns and likelihood of long-term use.
In the report, the researchers evaluated a representative sample of opioid-naïve, cancer-free patients who received opioid prescriptions. They found that the likelihood of chronic opioid use after 1 and 3 years increased with each additional day of medication supplied, starting with the third day.
The most dramatic surges in chronic opioid use were seen after:
  • The fifth and thirty-first days of therapy
  • A second prescription or refill
  • 700 morphine milligram equivalents cumulative dose
  • An initial 10- or 30-day supply 
The highest likelihood of continued chronic opioid use was seen in patients who started on a long-acting opioid use, following by patients who began with tramadol.
The researchers noted that tramadol’s high association with chronic use was unexpected, since tramadol is deemed a relatively safe opioid with low abuse potential. However, 64% of patients who began tramadol treatment continued use after 1 year. The researchers suggested that tramadol may be intentionally prescribed to relieve chronic pain.
The study authors concluded that adhering to the shortest duration possible of opioid treatment is recommended, and that prescribing no more than 7 days (ideally less than 3) worth of opioids could help decrease the likelihood of unintentional chronic use.
Additionally, the results have counseling implications as well, indicating that health care providers should discuss patients’ use of long-term opioids to manage pain while still early in the opioid prescribing process.
Shah A, Hayes CJ, Martin BC. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use – United States, 2006-2015. Weekly. 2017. 66(10);265-269.