Individuals With Sustained or Increasing Opioid Use Were Older, Had More Comorbidities, Higher Use of Other Drugs

The widespread use of opioids for the treatment of pain carries concerns about the risks, potential dependence, and increased mortality of long-term use. Although previous research has attempted to measure rates of long-term opioid use, fewer studies have investigated the individual-level opioid use trajectories. The authors of research published in JAMA Network Open aimed to identify 5-year trajectories of prescription opioid use after initiation and examine the characteristics of each patient group.

Open prescription opioid bottle | Kimberly Boyles | stock.adobe.com

This study examined a total population of 3,474,490 individuals that consisted of adult residents aged ≥18 years who initiated a prescription for opioids between July 1, 2003, and December 31, 2018, who had at least 12 months of previous data and at least 2 months of follow-up beyond cohort entry. Of the total study population, 1,831,230 were females (52.7%) and 1,643,260 (47.3%) were males, with a mean (SD) age of 49.7 years with approximately 26.0% aged 65 years or older.

Opioids included in the study were buprenorphine, codeine, dextropropoxyphene, fentanyl, hydromorphone, methadone, morphine, oxycodone, pethidine, tapentadol, and tramadol, with dispensed methadone and buprenorphine for the treatment of opioid dependence not being recorded. Study observation began at patient cohort entry, and follow-up for each individual ended after 5 years. Further, prescriptions that were distributed privately to an individual—the recipient pays the full cost—or to public hospital inpatients were not captured in the study.

Study results suggest that most individuals beginning treatment with prescription opioids had relatively low and time-limited exposure to opioids (92.0% of total participants) over a 5-year period. Investigators identified 5 trajectories of opioid use on dispensing frequency over 60 months: very low use (75.4%), low use (16.6%), moderate decreasing to low use (2.6%), low increasing to moderate use (2.6%), and sustained use (2.8%). The very low use group consisted of the largest percentage of younger individuals, whereas the sustained use group consisted of the highest percentage of older people (65 years of age or older representing 22.0% of the very low use group versus 58.4% of the sustained use group).

Compared to individuals in the very low use trajectory group, the participants who were in the sustained use group were shown to have more comorbidities, including cancer (4.1% versus 22.2%); had increased health services contact, including hospital admissions (36.9% versus 51.6%); had higher use of psychotropic (16.4% versus 42.4%) and other analgesic drugs (22.9% versus 47.3%) prior to opioid initiation and were initiated on stronger opioids (20.0% versus 50.2%); however, this is likely due to a higher prevalence of pain and treatment needs in these individuals, according to the study authors.

There were several limitations in the study including the availability of low-dose formulations of codeine without prescription and opioids dispensed through private prescriptions or administered in public hospitals that were not captured in the data. Further, available data sets did not provide any information about dose, indication, or intended treatment duration of opioids, and dispensed quantities were not examined. The unrefined exposure measure (evidence of ≥1 opioid dispensed each month) did not account of whether people had used distributed opioids, or whether time-dependent factors were taken into consideration.

The information gathered on the individual characteristics of participants with different trajectories of opioid use can be used to prevent potential future harms from long-term opioid with the utilization of targeted monitoring and interventions.

Reference

Gisev N, Buizen L, Hopkins RE, et al. Five-Year Trajectories of Prescription Opioid Use. JAMA Netw Open. 2023;6(8):e2328159. doi:10.1001/jamanetworkopen.2023.28159