The reviewed studies show an increasing risk of serious adverse health outcomes-including misuse, overdose, and death-associated with increasing opioid analgesic dose. Further research is needed to characterize the relationship between opioid analgesic dose and the risk of addiction and abuse. This analysis could inform policy actions for regulators and clinical decision making for providers.

Key Points Question What percentage of patients receiving long-term immediate-release (IR) opioid analgesic therapy in the United States adds or switches to an extended-release/long-acting (ER/LA) formulation? Findings In this cohort study, most patients (96.0%) receiving IR formulations for 90 days or longer continued IR opioid analgesic use without adding (3.3%) or switching (0.7%) to an ER/LA product. Furthermore, many patients received only 1 IR (40%) and/or 1 ER/LA (41%) prescription throughout the 12-year study period. Meaning Most patients receiving opioid analgesics use IR formulations, and patients receiving long-term IR opioid analgesic therapy are unlikely to add or switch to an ER/LA formulation.