With a 10-day supply of opioids, 1 in 5 become long-term users

[Z]

https://arstechnica.com/science/2017/03/with-a-10-day-supply-of-opioids-1-in-5-become-long-term-users/


The longer a person uses opioids, the greater the risk of forming a deadly addiction. But just how long does it take to switch from being a short-term user—say, while you’re dealing with pain after a surgery—to a long-term, potentially problematic user? A few weeks? A month?
According to a new study, that transition could take just a matter of days.

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When patients get an initial opioid prescription that’s just a one-day supply, they have about a six-percent chance of being on opioids for a year or longer. But if that first prescription is for a three-day supply, the probability of long-term use starts inching up. With an initial five-day supply, the chance jumps to about 10 percent. With a six-day supply, the chance hits 12 percent. With 10-day’s worth, the odds of still being on opioids a year later hits roughly 20 percent.
So, with an initial 10-day opioid prescription, about one-in-five patients become long-term users. That’s according to the new study’s lead author Bradley Martin, a professor of pharmaceutical evaluation and policy at the University of Arkansas for Medical Science. It’s a fast rise, Martin said to Ars. “We really didn’t expect that.”
And, according to the rest of the data—published Friday in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR)—things just keep getting worse from there.



To calculate the probabilities, Martin and his colleagues tracked the prescription records of nearly 1.3 million patients. Those patients were all 18 or older, cancer-free, and got at least one opioid prescription between June 2006 and September 2015. They also didn’t have any history of opioid abuse.
For patients who get a 30-day stash of opioid all at once for their initial prescription, the chance of being on opioids for a year rose to 45 percent. But, Martin says, getting that much in one go is uncommon. Only about seven percent of patients get such long-duration prescriptions in the study. Most people get about a week’s worth at a time.
People who got 30 days of opioid total—meaning they may have gotten multiple prescriptions or refills over time—had about a 30-percent probability of using opioids for a year. And they had a nearly 20-percent chance of being on them for three years.


Other factors that kicked up the chances of long-term use were long-acting opioids, getting a cumulative dose equivalent to more than 700 milligrams of morphine, and getting multiple prescriptions. One in seven who got a second opioid or a refill were on the addictive drugs for at least a year.
Martin says he hopes the fresh data will help prescribers make smart and informed choices when doling out the powerful drugs. Early last year, the CDC released guidelines for prescribing opioids, recommending weak, short doses, ideally three days for acute pain. The agency urged doctors to refrain from prescribing opioids for chronic pain, except for cancer patients and end-of-life care.
In the study, Martin and colleagues found that less than one percent of patients were prescribed powerful, long-acting opioids, which are used for chronic pain. This suggests that intentional chronic pain prescriptions are uncommon. But the authors did note that 10 percent of patients got tramadol, which is considered a relatively safe opioid. So this may hint that some intentional prescriptions for chronic pain is going on.
The CDC estimates that 91 people die of an opioid overdose every day in the US.

[Snout]

This is very interesting, it kind of validated my own research, which suggests that if one does heroin every day for 10 years, one has a small but real chance of becoming addicted.

[Z]

That's pretty funny snout.  After 10 years of daily heroin O think most people are lifers. Just to get to that point is impressive.  Most heroin addicts end up dead before that from my experience.


The study doesn't account for some things too.  Longer scripts represent more serious issues that are more likely to lead to longer term pain killers being prescribed.

[Snout]

I was just being silly. The iatrogenic route to junkiedom interests me. I started with heroin as a teenager, so Ive always been curious about those who went down the doctor path....

[OpiXPO]

Terribly written article on a potentially enlightening study in my opinion. Are they saying that if you're on opiates for a year you're automatically an addict? All that this article's FACTS report is that if you're on it for a longer time, your more likely to end up being on it long term, and that goes without saying.  The image she linked to helping bolster the article is even a terrible visual aid. The text at the top of it shows an asterisk after one of the words implying that there is a specific context to the image, but that information that puts it into context is cut out.

Bad article in my not so humble opinion.

[bignasty]

That’s according to the new study’s lead author Bradley Martin, a professor of pharmaceutical evaluation and policy at the University of Arkansas for Medical Science.

I went to their methadone clinic at UAMS. I only went there for a few weeks because they wouldn't up my dose above 60 or 80 mgs (can't remember but I really think it was 60) since I had a script for benzos. That place SUCKED but they did do a lot of interesting research. They did research for that naloxogel or whatever it is that's used for opiate induced constipation that you see commercials for now. Then, they had hand-outs and ran commercials on the radio for "folks that use methamphetamine daily can take part in our study and get paid for it". They were trying to give them Vyvanse as a maintenance med to see if their meth use would decline. They also did a lot of buprenorphine studies. I can't remember exactly what they were but I remember them giving another medicine on top of sub to see if it would make it worker better. Their clinic was awful but some of their doctors were really on the cutting edge of addiction research.

[makita]

Terribly written article on a potentially enlightening study in my opinion. Are they saying that if you're on opiates for a year you're automatically an addict? All that this article's FACTS report is that if you're on it for a longer time, your more likely to end up being on it long term, and that goes without saying.  The image she linked to helping bolster the article is even a terrible visual aid. The text at the top of it shows an asterisk after one of the words implying that there is a specific context to the image, but that information that puts it into context is cut out.

Bad article in my not so humble opinion.

Totally agreed.  It's also another one of those correllation =/ causation fuckups that the media always does re: drugs.  Gee...maybe people who get longer initial prescriptions of opioids do so because they are in more severe acute or extended pain, and therefore are more likely to continue to be in pain a year later and so continue to need them?  The pain is the causal factor of both the short and long term prescriptions.  This isn't fucking rocket science.

The implications of studies like these for most of the ignorant public is usually something like "hey! if we give them less opioids to begin with, we'll be less likely for them to become dependent long term [ie "addicted", which is totally 100% the same thing of course].  Let's make a rule that Drs can only prescribe 3 days of opiates at a time!"  Meanwhile the person is fucking miserable...but at least they're not an opioid user!  Oh wait now they're in so much pain they can't function, their bodies aren't healing properly, and so they're buying pills off their friends/the internet...and now thanks to the DEA's witch hunt those are too expensive, so they're using dope.  But that's THEIR problem for being weak and immoral junkies, right?  /s

[Raine]

Terribly written article on a potentially enlightening study in my opinion. Are they saying that if you're on opiates for a year you're automatically an addict? All that this article's FACTS report is that if you're on it for a longer time, your more likely to end up being on it long term, and that goes without saying.  The image she linked to helping bolster the article is even a terrible visual aid. The text at the top of it shows an asterisk after one of the words implying that there is a specific context to the image, but that information that puts it into context is cut out.

Bad article in my not so humble opinion.

Totally agreed.  It's also another one of those correllation =/ causation fuckups that the media always does re: drugs.  Gee...maybe people who get longer initial prescriptions of opioids do so because they are in more severe acute or extended pain, and therefore are more likely to continue to be in pain a year later and so continue to need them?

And yet this can and/or will be used as more reason to deny people in actual pain
access to meds at a level needed to keep them functioning.