Opioid prescription and use is a highly contested subject. It is great for pain management, but the contention against it is justified: when taken for too long or in too high a dosage, the addictive nature of opioids presents a major threat to patient health.
The elderly are an especially susceptible population of opioid users since they are more heavily influenced by the numbing effects of the drug, which increases the risk of falls, fractures, and deaths. In the past decade or so, deaths due to opioids among the elderly Medicare population has increased fivefold (Barnett et. al, 2017).
Some argue that physician over-prescription is a major factor in hospitalizations resulting from opioid use. Researchers postulate that these deaths and injuries may be at least partially attributed to the absence of regulation in dosage and frequency of opioid prescription among physicians.
Overprescription of opioids may be linked to long-term use of the drug.
Image Source: Arman Zhenikeyev – professional photographer from Kazakhstan
A recent study published in the New England Journal of Medicine set out to examine the discrepancies in opioid prescription frequency and dosage among physicians within the same hospital emergency room to elderly Medicare patients. Researchers identified physicians who were high and low-frequency opioid prescribers and followed each group’s patients to identify how the long-term usage and hospitalizations differed between the two groups. The article defined long-term usage as “180 days or more of opioids supplied in the 12 months after an index emergency department visit” (Barnett et. al, 2017).
The study found that patients who received a higher frequency and intensity of opioid prescriptions were more likely to demonstrate long-term opioid use at 12 months. The initial exposure to physician-prescribed opioids is thought to increase chances of prolonged use. It is hoped that future research in this area can corroborate the conclusions drawn from this study.
Finally, how can these results inform future medical practice?
Perhaps physicians should be warier when prescribing opioids, starting with a smaller and shorter initial dose to minimize the risk of the patient developing a long-term habit. The CDC recommends less than three days as an ideal prescription window, because chances of long term use increase after 5 days and greatly increase after 31 days of use. Research shows that the initial dose could be the starting point that can lead to prolonged use of opioids, so by reducing initial exposure, physicians may be able to curb the number of people who eventually become long-term users.
Feature Image Source: Pills Medicine Health by Matvevna
