30% Of Patients Prescribed Opioids For More Than A Month Still On Them A Year Later

From a review of 1,294,247 patient records from a database of commercial health plan information from a large number of managed care plans and is representative of the U.S. commercially insured population.

The rate of long-term use was relatively low (6.0% on opioids 1 year later) for persons with at least 1 day of opioid therapy, but increased to 13.5% for persons whose first episode of use was for ≥8 days and to 29.9% when the first episode of use was for ≥31 days.

(The study excluded patients with a substance abuse disorder diagnosis.)

CORRECTION: The title of this post has been corrected. It originally read, “Almost Half Of Patients Prescribed Opioids For A Month Get Hooked For A Year”. This is a good reminder of the Joint Commission’s lesson to not trust other people’s characterization of research and always read the source material.

3 Comments

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3 responses to “30% Of Patients Prescribed Opioids For More Than A Month Still On Them A Year Later

  1. Joe

    How does this impact the disease model of addiction? We are often reminded that addiction is a primary disease, affecting less than 10% of population. That very few people report positive feeling on opiates, many with nausea, fatigue, and confusion. Upon discharge or discontinued use of opioid 90%+ have no trouble stopping, in fact prefer it to the other effects they find unpleasant.

    Or. Does the addiction model need to take into account a more holistic reality? Those geographical areas mentioned are terribly depressed economically with all sorts of consequential social pathologies being reported, addiction being just one.

    If so, doesn’t that lend support to the argument that addiction is driven by socio-economic factors? And that as long as our society continues to see a widening income disparity, and it looks not too abate anytime soon, we can expect addiction to increase?

    Seems to me, if you want to reduce addiction, you best improve the economic lives of these communities, allowing for more hope and a richer community experience.

    • I’m not sure I see any meaningful implications for the disease model. Here’s why, but let me know what I’m missing.

      First, this study was looking at a database this study draws from is described as “commercial health plan information from a large number of managed care plans and is representative of the U.S. commercially insured population.” Further, it doesn’t appear to draw from any particular geographic area. So, to me, this would suggest that vulnerability to long term use is independent of “geographical areas [that] are terribly depressed economically with all sorts of consequential social pathologies”.

      Second, this study really only speak to the relationship between the length of the initial prescription (and the specific medication) and being on opioids a year later. The relationship between this and addiction (the severe, chronic form, characterized by loss of control) are not clear to me. (And the disease model only applies to addiction, not the less severe SUDs.)

      Third, even if there is a relationship between addiction and environmental factors, it’s not clear to me what this would say anything about the validity of the disease model. Recent attention to social determinants of health make it clear that environmental and social factors can influence the vulnerability, trajectory, and response to treatment for many diseases without being causative.

      So, assuming social determinants can influence the vulnerability, trajectory, and response to treatment, but don’t cause the disease. Addressing social factors would help, but not be sufficient.

      Check this out on the concept of healing forests.

      • Joe

        Thanks for reply.
        You make great points, especially my assumption of chronic abuse vs use

        My interest more and more is finding links income/wealth disparity and concomitant health issues.

        Just read an article about Iceland and how they are dealing with substance abuse. After school peer activities and richer community ties for entire family. The idea of belonging. AA, life many civic groups harnesses the power of belonging to the group.

        Healing Forest very cool blog.