Four factors can predict the likelihood of chronic opioid use, according to research from West Virginia University.
The study, led by Nilanjana Dwibedi, assistant professor in the WVU School of Pharmacy, is the first of its kind to investigate the risk of developing chronic opioid use among patients with noncancer pain. Chronic opioid use refers to an opioid therapy regimen prescribed by a doctor in a controlled setting.
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Opioids have become increasingly prescribed for noncancer pain at alarming rates over the past 20 years. Initially, pharmaceutical companies said that patients would not become addicted to opioids, and the number of prescription opioids sold to hospitals, pharmacies and doctors’ offices nearly quadrupled between 1999 and 2010. We now know that opioids are highly addictive, and the consequences of opioid use and misuse are severe: lost jobs, missed work, overdose and death. Opioids were involved in 42,249 deaths in 2016–five times higher than in 1999.
WVU’s findings, published in the journal American Health & Drug Benefits, identify four factors that can predict a patient’s transition to chronic opioid use:
- The opioid’s duration of action (long-acting opioids v. short-acting opioids).
- The types of parent opioid compounds.
- A patient’s history of drug use disorder.
- A patient’s medical conditions associated with pain, such as recovery from surgery.
Researchers define opioid therapy as “chronic” if a patient is prescribed at least a 90-day supply of an opioid within 4 months of an initial, short-term opioid prescription. According to research, patients were more likely to begin chronic opioid therapy if their initial, short-term opioid regimen involved a long-acting opioid instead of short-acting one.
Understanding which factors can lead to chronic opioid use could influence policymakers, educate prescribers, help clinicians make more informed treatment decisions and change how doctors monitor patients through follow-up appointments. Chronic opioid use, even in a controlled setting, can increase a patient’s risk of developing opioid addiction, as well as other health issues.
“Let me tell you: when a physician prescribes medications, if he or she doesn’t know what can cause that patient to be addicted in the future, then the physician has no control to prevent future misuse or abuse. This should be the first step to prevent the opioid epidemic,” Dwibedi said. “The prevention should start from patient and physician.”
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The study reviewed a sample of approximately 500,000 patients’ medical and pharmaceutical insurance claims. Researchers used predictive models that considered patient’s physical and mental health, pain conditions and other medications, in addition to other variables. Patients were working-aged adults who were enrolled in a commercial health plan who did not have cancer and began opioid therapy between January 2007 and May 2015.
The opioid epidemic has had a devastating impact throughout the United States, but West Virginia has been hit especially hard. In fact, WVU’s chief economist estimates that the opioid crisis has cost the state a whopping $1 billion.
Understanding these risks can help doctors make better treatment decisions by connecting at-risk patients with safer, non-addictive opioid alternatives, if appropriate. Still, the opioid epidemic isn’t showing any signs of slowing down. Although prevention is critical, there are thousands of people who are already dealing with opioid use disorder. Comprehensive, individualized and accessible opioid addiction treatment is arguably the most useful tool in fighting the epidemic.
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