Boston—How long matters more than how much when it comes to misuse and addiction issues with opioid painkillers, according to a new study.

Harvard Medical School–led researchers found that prescribing higher opioid doses for shorter durations may be a more effective way to treat pain after surgery. The results published in The BMJ (British Medical Journal) called into question some clinical guidelines that recommend taking only low doses for a short time.

Reviewed for the study were slightly more than one million commercially insured U.S. patients without a history of misuse or ongoing opioid use and who underwent routine surgery between 2008 and 2016. Administrative data was used to track prescription refills for oral opioids after discharge, and diagnostic coding data was employed to identify opioid dependence, abuse, or overdose.

With 568,612 (56%) patients receiving prescriptions for postoperative opioids, 90% of which were filled within 3 days of hospital discharge, misuse was identified in 0.6% of patients during a follow-up period of about 2.5 years. While misuse rates were low, researchers note, analysis indicates that misuse appeared to increase with each opioid prescription refill.

After taking into account other potentially influential factors, the report said that each opioid-prescription refill was associated with a 44% increase in misuse, while each additional week of opioid use was associated with a 20% increase in the risk of misuse among the patients.

Duration of the prescription rather than dose seemed to be more strongly associated with ultimate misuse in the early postsurgical period, with even high doses associated with only mild increases in risk of misuse when duration was short, the researchers stated.

“Each refill and week of opioid prescription is associated with a large increase in opioid misuse among opioid naive patients,” study authors conclude. “The data from this study suggest that duration of the prescription rather than dosage is more strongly associated with ultimate misuse in the early postsurgical period. The analysis quantifies the association of prescribing choices on opioid misuse and identifies levers for possible impact.”

Although an observational study from which no conclusions can be drawn about cause and effect, the researchers point out that the size of their analysis allowed them to account for a range of potentially influential factors, so that their results provide “a broad evidentiary framework to inform clinician behavior and promote protocol development.” They suggest that “Further research of this relation is needed to determine how initial treatment regimens can minimize misuse and addiction.”
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