Substance Use Disorders in a Primary Care Sample Receiving Daily Opioid Therapy

Fleming, Michael F.; Balousek, Stacey L.; Klessig, Cynthia L.; Mundt, Marlon; Brown, David

doi:10.1016/j.jpain.2007.02.432

Cited by 246 publications

(193 citation statements)

References 38 publications

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“…In previous studies, the proportion of patients receiving early opioid refills ranged from 4% to 41%, 17,18,44 and 15% in a primary care setting. 17 We found that 23% of our cohort received more than one early opioid refill.…”

Section: Discussionmentioning

confidence: 94%

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

et al. 2011

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Section: Discussionmentioning

confidence: 94%

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

et al. 2011

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“…We did not try to identify or define dependency, misuse, abuse, or addiction, though these in turn are associated with long-term use. [5][6][7][8]10 Analysis. Chi-square and related tests for trend were used to compare demographic features of patients who did or did not initiate long-term opioid use.…”

Section: Inclusion Of Patients and Prescriptions And Dosingmentioning

confidence: 99%

“…4 For non-cancer conditions, long-term use is problematic because of substantial rates of dependence and misuse, and because efficacy of long-term therapy remains unproven. [5][6][7][8] Emergence of drug tolerance and hyperalgesia may limit long-term efficacy. 9 Several factors may explain the emergence of inadvertent longterm use, including opioid dependence, non-medical use, substance use disorders, and diversion to other users.…”

Section: Introductionmentioning

confidence: 99%

Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients: A Statewide Retrospective Cohort Study

et al. 2016

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BACKGROUND: Long-term efficacy of opioids for noncancer pain is unproven, but risks argue for cautious prescribing. Few data suggest how long or how much opioid can be prescribed for opioid-naïve patients without inadvertently promoting long-term use. OBJECTIVE: To examine the association between initial opioid prescribing patterns and likelihood of long-term use among opioid-naïve patients. DESIGN: Retrospective cohort study; data from Oregon resident prescriptions linked to death certificates and hospital discharges. PARTICIPANTS: Patients filling opioid prescriptions between October 1, 2012, and September 30, 2013, with no opioid fills for the previous 365 days. Subgroup analyses examined patients under age 45 who did not die in the follow-up year, excluding most cancer or palliative care patients. MAIN MEASURES: Exposure: Numbers of prescription fills and cumulative morphine milligram equivalents (MMEs) dispensed during 30 days following opioid initiation (Binitiation month^). Outcome: Proportion of patients with six or more opioid fills during the subsequent year (Blong-term users^). KEY RESULTS: There were 536,767 opioid-naïve patients who filled an opioid prescription. Of these, 26,785 (5.0 %) became long-term users. Numbers of fills and cumulative MMEs during the initiation month were associated with long-term use. Among patients under age 45 using short-acting opioids who did not die in the follow-up year, the adjusted odds ratio (OR) for long-term use among those receiving two fills versus one was 2.25 (95 % CI: 2.17, 2.33). Compared to those who received < 120 total MMEs, those who received between 400 and 799 had an OR of 2.96 (95 % CI: 2.81, 3.11). Patients initiating with long-acting opioids had a higher risk of long-term use than those initiating with short-acting drugs.CONCLUSIONS: Early opioid prescribing patterns are associated with long-term use. While patient characteristics are important, clinicians have greater control over initial prescribing. Our findings may help minimize the risk of inadvertently initiating long-term opioid use.

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“…There is a disproportionately high prevalence of SUDs among CNCP patients. 9 Although rates vary by setting and type of substance being assessed, approximately 10% of CNCP in primary care 10,11 and 10-30% of patients in specialty pain clinics [12][13][14] have a current SUD. CNCP patients with a history of SUD are more likely to receive opioids for CNCP and at higher daily dose than patients without history of SUD.…”

Section: Introductionmentioning

confidence: 99%

Adherence to Clinical Guidelines for Opioid Therapy for Chronic Pain in Patients with Substance Use Disorder

2011

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Substance Use Disorders in a Primary Care Sample Receiving Daily Opioid Therapy

Abstract: This study found that the frequency of opioid use disorders was 4 times higher in patients receiving opioid therapy compared with general population samples (3.8% vs 0.9%). The study also provides quantitative data linking aberrant drug behaviors to opioid use disorders.

Cited by 246 publications

References 38 publications

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients: A Statewide Retrospective Cohort Study

Adherence to Clinical Guidelines for Opioid Therapy for Chronic Pain in Patients with Substance Use Disorder

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