A quarter of patients prescribed opioids for the first time end up progressing to longer-term prescriptions, according to US researchers.
Identifying who is likeliest to end up using the drugs long-term is critically important due to the widespread problems associated with their misuse, said the study authors.
To try to identify those most at risk opioid painkiller addiction and accidental overdoses, the researchers studied how many patients prescribed an opioid painkiller for the first time progressed to long-term prescriptions.
“More people now are experiencing fatal overdoses related to opioid use than compared to heroin and cocaine combined”
They found the answer was one in four, with patients with histories of tobacco use and substance abuse most likely to use opioid painkillers long-term.
Researchers looked at a random sample of 293 patients who received a new prescription in 2009 for an opioid painkiller – such as oxycodone, morphine, hydromorphone, oxymorphone, hydrocodone, fentanyl, meperidine, codeine and methadone.
They found that 21%, or 61 people, progressed from short-term use to prescriptions lasting three to four months, and 6%, or 19, of the 293 studied ended up with more than a four-month supply of the drugs.
The findings are published in the journal Mayo Clinic Proceedings.
Lead author Dr Michael Hooten said the identification of nicotine use and substance abuse as top risk factors for long-term use of opioids suggested that clinicians should be particularly careful about prescribing the painkillers to patients with such histories.
In addition, he said that while the study identified nicotine use and substance abuse as top risk factors for long-term use of opioids, all patients should proceed with caution when offered opioid painkiller prescriptions.
Long-term opioid use may make people more sensitive to pain via a condition called opioid-induced hyperalgesia, he suggested.
If opioids must be used, as is usually the case with surgery or traumatic injuries, reducing the dose and limiting the duration of use is important, added Dr Hooten.