An Updated View on the Initial Opioid Prescription Characteristics and Pain Etiologies That Influence Long-Term Opioid Use Among Opioid Naïve Patients

OBJECTIVES: This retrospective cohort study provides an updated view on the association between the likelihood of continued opioid use among opioid-naïve patients and characteristics of the initial opioid prescription and initial opioid prescription episode utilizing IQVIA PharMetrics®Plus for Academics commercial health plan database representative of commercially insured patients across the US.

METHODS: Kaplan-Meier estimates were used to determine the probability of opioid continuation at 365 days stratified by the characteristics of the initial opioid prescription and initial opioid prescription episode. Cox-proportional hazards models were estimated to determine the strength of association between initial opioid prescription characteristics and the likelihood of opioid continuation.

RESULTS: A total of 578,403 cancer-free, SUD-free, opioid-naïve subjects aged > 14 years that filled > 1 opioid prescriptions between April 13, 2016 and April 18, 2020 were identified and categorized based on time to opioid discontinuation. After accounting for censoring, 5.05% of persons continued opioid use for >365 days. Compared to a 1-2 days’ supply, the likelihood of opioid discontinuation was consistently lower with higher days’ supply [HRs (CIs): 3–4 days' supply = 0.66 (0.65-0.66); 5–7 days' supply = 0.41 (0.41-0.41); 8–10 days' supply = 0.33 (0.33-0.34); 11–14 days' supply = 0.30 (0.29-0.31); 15–21 days’ supply = 0.26 (0.26-0.27); ≥22 days’ supply = 0.17 (0.17-0.18)]. These associations between increased days’ supply and decreased likelihood of discontinuing opioid remained consistent across different pain etiologies.

CONCLUSIONS: In this era of more judicious opioid prescribing, new episodes of opioid prescribing are less likely to transition to long-term opioid use (LTOU) among US commercially insured patients receiving opioid prescriptions. However, the strength of association between LTOU and the characteristics of the initial opioid prescription remains largely unchanged, namely there still exists a strong relationship between longer days’ supply and a higher likelihood of LTOU.