Long-term opioid therapy definitions and predictors: A systematic review

Area of Science:

• Pharmacology
• Public Health
• Clinical Medicine

Background:

• Long-term opioid therapy (LTOT) is increasingly common for chronic pain management.
• Standardized definitions and understanding of LTOT predictors are crucial for safe prescribing.
• Opioid-naïve individuals transitioning to LTOT require careful monitoring.

Purpose of the Study:

• To systematically review and describe outcome measure definitions for long-term opioid therapy (LTOT).
• To identify predictors associated with the transition from short-term opioid use to LTOT in opioid-naïve individuals.

Main Methods:

• Systematic review of peer-reviewed literature from January 2007 to July 2018.
• Inclusion of studies examining opioid use exceeding 30 days.
• Extraction of LTOT definitions and predictors from multivariate models.

Main Results:

• 34 studies were included, yielding 41 unique LTOT definitions.
• Definitions varied, with 36% requiring 3 months of use; few considered consistent use or dose.
• Common predictors for LTOT included comorbidities (21.1%), non-opioid prescriptions (13.2%), and substance use disorders (10.5%).

Conclusions:

• Existing LTOT definitions are inconsistent and often lack criteria for consistent use.
• Predictors of LTOT initiation resemble known risk factors for opioid misuse and overdose.
• Future research should focus on consistent use criteria for safer LTOT practices.