Initial Events Associated With Sustained Opioid Use

Opioids are used for an extended period of time due to either nonspecific diagnoses or linked with spinal or other conditions, and not due to hospital events and associated procedures.

Most of the events that led to extended use of opioids were found to be due to either nonspecific diagnoses or the one's linked with spinal or other conditions for which opioid administration has not been considered standard of care, and not due to hospital events and associated procedures, reveals a new study published by JAMA Surgery.//

The initial event associated with exposure to prescription opioids has not been widely explored, but is often maintained to stem from an injury or surgical procedure.

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‘The most frequent diagnoses in both civilian and military settings are spinal and orthopedic conditions, where the initial opioids are prescribed.’

Andrew J. Schoenfeld, M.D., M.Sc., of Brigham and Women's Hospital, Harvard Medical School, Boston, and colleagues evaluated the medical diagnoses linked with an opioid prescription that resulted in sustained opioid use in Americans insured through TRICARE, the insurance plan of the U.S. Department of Defense that provides health care coverage for over 9 million beneficiaries.

This population may be comparable to the proportion of the general public at greatest risk of sustained opioid use.

The researchers identified 117,118 patients (opioid naïve, i.e., no use of prescription opioids for six months before receipt of a new prescription) who met the criteria for sustained prescription opioid use.

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Only 800 individuals (0.7 percent) received their initial opioid prescription following an inpatient encounter, with 0.4 percent having undergone an inpatient procedure.

The most common diagnosis associated with the initial opioid prescription for the entire group was other ill-defined conditions (30.6 percent).

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The most frequent diagnosis among patients treated in military facilities was lumbago. Spinal conditions were among the most frequent diagnoses in both civilian and military settings.

Among specific categories of conditions associated with the initial opioid prescription, spine and orthopedic disorders were the most prominent.

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Limitations of the study include its retrospective design and reliance on insurance claims.

"Improved adherence to best practices in opioid prescribing and requirements for better documentation of the rationale for such prescriptions may reduce the risk of sustained use," the authors write.

Source-Eurekalert