The best way to curb the opioid addiction crisis is to prevent new people from becoming dependent in the first place. Yet doctors who treat patients with severe pain have few effective approved alternatives to prescribe (there are experimental ones that show promise), and it is extremely difficult to predict which individuals are more likely to start relying on these substances long-term considering the myriad of physiological, psychological, economic, and social factors that contribute to both addiction and chronic pain.
Though many studies have looked at dependency in specific patient groups, like people recovering from surgery or the elderly, there have been few large-scale studies conducted on diverse groups whose findings can be used to draw guidelines for the general population.
To fill this gap, a team of researchers from several US universities examined medical insurance data from more than 491,000 adults, aged 28 to 63, who had been treated before and after receiving an opioid drug prescription for non-cancer pain. Their analysis, published in American Health & Drug Benefits, is the first large-scale study to examine this issue in working-age adults, the age group that makes up the brunt of opioid dependence cases.
Overall, the authors found that patients given long-acting formulations rather than short-acting (37 vs 1.3 percent), high-dose initial courses rather than low-dose (5.1 vs 1.5 percent), and tramadol rather than codeine-based compounds (4.2 vs 0.5 percent) were far more likely to become long-term opioid users – an outcome defined by the patient filling 90 days' worth of opioids at least 120 days after an initial prescription.
“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,” stated author Nilanjana Dwibedi. “The prevention should start from patient and physician.”
In line with previous investigations, individuals who had recently used stimulants (such as pseudoephedrine) or benzodiazepines (such as Valium or Xanax), were also at increased risk of dependence. And, as one would expect, patients whose conditions were more likely to cause chronic pain and those with a history of drug abuse disorders showed higher rates of long-term use.
Despite the usefulness of these findings, the authors concede that using insurance data is limiting, as it does not include important information about what would be present in a medical chart and it cannot account for whether or not patients actually took all the pills in a filled prescription.
Furthermore, the rates of conversion to opioid dependency may be underrepresented because patients could have turned to illegally obtained street drugs if their provider refused to give them more prescriptions.