Long-term opioid therapy reconsidered.

Area of Science:

• Pain Management
• Public Health
• Pharmacology

Background:

• Long-term opioid therapy prescribing has significantly increased in primary care over the last two decades.
• This rise in prescriptions has occurred without a commensurate increase in supporting evidence.
• Increased opioid availability is linked to widespread opioid abuse and overdose epidemics.

Purpose of the Study:

• To review the current evidence on the efficacy and risks of long-term opioid therapy.
• To highlight knowledge gaps and emerging data on adverse events associated with opioid use.
• To provide guidance on cautious and selective prescribing practices for long-term opioid therapy.

Main Methods:

• Literature review of recent studies and data on opioid prescribing trends.
• Analysis of research on opioid addiction rates in patients on long-term therapy.
• Examination of reported serious adverse events and dose-related risks.

Main Results:

• The rate of opioid addiction in patients on long-term therapy is uncertain but misuse appears common.
• Increased risks for fractures, cardiovascular events, and bowel obstruction are reported, with risks potentially escalating with higher doses.
• Higher-dose regimens constitute the majority of dispensed opioids, indicating significant societal risk.

Conclusions:

• Greater caution and selectivity are necessary when prescribing long-term opioid therapy due to significant risks and knowledge gaps.
• Clinicians should prioritize patient benefit and minimize risks by erring on the side of caution.
• Cautious dosing and limiting therapy to cases with decisive benefits may reduce diversion and adverse effects.