Associations between initial opioid exposure and the likelihood for long-term use.

Area of Science:

• Pharmacology and Pharmaceutics
• Public Health
• Health Services Research

Background:

• Opioid prescribing patterns have shifted, with a general decline in recent years.
• Understanding the factors influencing the transition from initial opioid exposure to long-term use is critical for public health interventions.
• The Veterans Affairs (VA) healthcare system provides a large, well-documented patient population for studying opioid use trajectories.

Purpose of the Study:

• To examine the association between initial opioid exposure characteristics and subsequent long-term opioid use.
• To compare these associations in two distinct cohorts (2011 and 2016) to assess temporal trends.
• To identify key predictors of progression to long-term opioid use.

Main Methods:

• Two national Veterans Administration (VA) cohorts from 2011 and 2016 were analyzed.
• Incident opioid users were identified, and methodologies were employed to determine the relationship between initial exposure (days' supply, dose, fills) and long-term use.
• Multivariable modeling was used to identify predictors of long-term opioid use.

Main Results:

• The percentage of incident opioid users progressing to long-term use decreased from 2011 to 2016.
• Cumulative days' supply of the initial opioid prescription was the strongest predictor of long-term opioid use.
• Patients receiving longer initial supplies (e.g., >30 days) had a substantially higher risk of long-term use compared to those receiving shorter supplies (e.g., ≤7 days).

Conclusions:

• A strong relationship persists between initial opioid exposure and the likelihood of long-term opioid use.
• The duration of the initial opioid supply is a critical factor in predicting long-term use.
• These findings support the development of targeted interventions, such as pharmacist-led medication management, to prevent inappropriate long-term opioid use.