According to researchers, focusing on minimizing opioid risk through dosage management may be misguided.
A study in BMJ led by investigators at Beth Israel Deaconess Medical Center and Harvard Medical School showed that among surgery patients, the duration of opioid treatment is a more potent predictor of abuse and overdose than dosage.
According to the researchers, focusing on minimizing risk through dosage management may be misguided. However, dosage does emerge as a powerful risk indicator among those who took the medications for extended periods.
“Our results indicate that each additional week of medication use, every refill is an important marker of risk for abuse or dependence," co-first author Denis Agniel, a statistician at the RAND Corporation and a part-time lecturer in the Department of Biomedical Informatics at Harvard Medical School, said in a statement.
In the study, none of the 560,000 patients had a record of chronic or extended opioid use leading up to surgery. For the purposes of the research, patients were deemed non-opioid users if they had not taken opioids in the two months prior to their surgery, or if they had used opioids for fewer than seven days prior to their procedure.
Of the more than half million patients, 0.6%, or 5,906, developed dependence, demonstrated symptoms of abuse, or experienced a nonfatal overdose. A third of the misuse diagnoses occurred within a year of the surgery.
Each additional week of opioid use increased the risk of dependence, abuse, or overdose by 20%. Each additional refill boosted the risk by 44%, the analysis showed, with the first refill more than doubling the risk.
By contrast, dosage played a far smaller role, the analysis showed. In fact, the researchers noted, among people taking opioids for short periods (two weeks or less), the risk for misuse was no greater even among patients on dosages that were twice as high.
However, higher dosage did propel risk significantly among those taking opioids for nine weeks or longer, a finding that suggests a potent confluence of duration and dosage among long-term users, the researchers said.
“As physicians, we face a dilemma with each opioid prescription, so we need a more nuanced understanding of how to weigh the risks and benefits of opioid pain management immediately after surgery, including factors that influence misuse,” Isaac Kohane, co-senior author on the study and head of the Department of Biomedical Informatics at Harvard Medical School, said in a statement.
“These results provide much-needed clarity,” he said.
Alexandra Wilson Pecci is an editor for HealthLeaders.
