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Duration, not dosage, is key in opioid problems, study finds

Every additional week of opioid medication use, every refill, increased the risk of problems, the study found.
Every additional week of opioid medication use, every refill, increased the risk of problems, the study found.(John Moore/Getty Images/File 2016)

The danger of getting addicted to opioids prescribed after surgery might depend less on the amount of the pills than on the length of time you take them, a new study from Harvard Medical School has found.

Researchers looked at more than half a million records of privately insured patients who were given opioids after surgery between 2008 and 2016 to see how many suffered opioid misuse problems afterward. The results are being published Saturday in BMJ, formerly the British Medical Journal.

Every additional week of medication use, every refill, increased the risk of problems, the study found.

“As surgeons, we often struggle to balance the risk of abuse with our duty to manage pain, but our findings underscore how potent a single stroke of the pen can be in fueling this risk,” co-first author Gabriel Brat, an instructor at the school and a trauma surgeon at Beth Israel Deaconess Medical Center, said in a statement from the school.

Doctors’ prescription practices have been under the microscope because of the opioid abuse epidemic that is ravaging America. The CDC says that an estimated 63,600 people died of drug overdoses in 2016, two-thirds of them from opioids.

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Doctors have been advised to use the lowest possible doses and not to prescribe the medicines for longer than is necessary. The new research highlighted the importance of the latter piece of advice.

The researchers looked at about 560,000 patients with no record of chronic or extended opioid use leading up to surgery who got opioids for their post-surgical pain.

Of that number, 0.6 percent, or 5,906 people, developed dependence, symptoms of abuse, or experienced a nonfatal overdose, which the researchers defined as “opioid misuse,” the statement said.

The researchers said each additional week of opioid prescription use increased the risk of opioid misuse by 20 percent. Each refill increased the risk of opioid misuse by 44 percent, researchers said.

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Dosage, the amount of medication the patients took over 24 hours, was not as strong a predictor of problems, the statement said. For people taking opioids for two weeks or fewer, the risk of opioid misuse was no greater even if they were taking twice as high a dose.

Dosage did matter, however, in cases where people took the drugs for longer periods. When people took the drugs for nine weeks or longer, higher dosages did “propel risk significantly,” the statement said.

The researchers suggested that surgeons should quickly refer patients to chronic pain specialists if they have persistent pain.

They hoped that their research could inform guidelines for opioid prescribing after surgery and called for further research into whether the best post-surgical prescription plan could be “moderate to high doses at shorter durations.”

Researchers from the medical school were joined in the study by researchers from the University of Florida at Jacksonville, Johns Hopkins University, and Aetna Inc.