OBJECTIVES: To assess the impact of initial opioid prescription dose and duration combinations on pain-related healthcare costs and utilization among opioid-naïve chronic pain patients.

METHODS: Patients with ≥2 same-site chronic pain diagnoses 3-12 months apart without cancer, palliative care, or prior opioid use were identified from 10/1/2015-06/30/2023 in a U.S. dataset that includes administrative and claims data for over 170 million patients across commercial payors, Medicare Advantage and Medicaid. Initial opioid prescriptions following the second diagnosis were categorized by “dose-days’ supplied” based on morphine milligram equivalent (MME) dosage (low [>0-20 mg], medium [>20–50], high [>50-90], very high [>90])) and duration (short [1-7 days], moderate [>7-30], long [>30-90], prolonged [>90]). Subsequent pain-related costs and resource use were assessed over 12 months. Log costs were modeled using a generalized linear model and utilization outcomes using logistic regressions, adjusting for age, pain site, payor, comorbidity score, opioid use disorder (OUD) status, and baseline all-cause medical costs.

RESULTS: Among 480,030 patients initiating opioids for chronic pain, most (99%) were prescribed low doses for short or moderate durations. Compared to low-short opioid initiators who had average(sd) annual pain-related costs of $1,741(52,996), costs increased by 36% for low-moderate, 39% for low-long, 34% for medium-short, 41% for medium-moderate, and 55% for medium-long initiators. Relative to low-short initiators, an initial medium-short prescription (N=442) was associated with increased risk of both pain-related hospitalization (OR 1.34; p<0.05) and emergency department visits (OR 2.02; p<0.01) during follow-up.

CONCLUSIONS: Most opioid-naïve chronic pain patients initially received low-dose opioids for short to moderate durations, aligning with 2022 CDC guidelines. Higher doses and longer durations at onset were associated with increased annual healthcare costs and utilization. Further research to understand the factors contributing to this observed trend is warranted.