Identifying Risk Factors of Long-Term Opioid Use

As the opioid crisis continues to wreak havoc across the nation, convincing evidence into the risk factors of long-term use could alter the way physicians conduct themselves in clinical practice. 


Findings of a recent study have the potential to do just that, as investigators found that in addition to injury, number of days’ supply was the strongest risk factor of developing long-term use among a population of injured workers. 



To determine what risk factors were associated with long-term opioid use after injury among a population of previously opioid-free individuals, investigators carried a cohort study that included 205,565 injured workers from Tennessee. Of that cohort, 128,885 met eligibility criteria and a population of 58,278 who received opioids in the 90 days after injury and were included in the final analysis.

Of the 58,278, 32.5% (18,977) were aged 15 to 34, 47.2% (27,514) were aged 35 to 54, and 20.2% (11,787) were aged 55 to 99 years. Men made up the majority (56.0%) of the study population. 



Upon analyses, investigators found 79.6% (46,399) of participants were opioid free at the time of injury. Of the 46,399 that received opioids, most had received their first prescription within a month of injury and 8319 received their first opioid prescription later.

Investigators noted that 1834 of those who received opioids began long-term use. Additionally, sustained use — defined as received an opioid most days for every 30-day period up to 90 days post-injury — was found in 1.7% of patients. The highest dose received in the first prescription by an opioid-free patient was 770 MME. 


There was a similar age distribution when comparing those who started using opioids late and those who began early. However, investigators found those who started late were more likely to be female(15 460 [48.9%] vs 4066 [40.6%]) and have back injuries (4760 [12.5%] vs 773 [9.3%]) and were less likely to have fractures (914 [2.0%] vs 915 [11.0%]).

When comparing previously opioid-free workers to those with a recent history of use, investigators found opioid-free workers were significantly more likely to be younger than 35 years (10,663 [34.8%] vs 1925 [24.0%]), male (17 687 [57.8%] vs 3921 [48.8%]), have a finger injury (3118 [10.2%] vs 603 [7.5%]), have a fracture (2755 [9.0%] vs 439 [5.5%]), and to be from an urban area (11,681 [38.2%] vs 2548 [31.7%]). 


After conducting analyses controlling for covariates, results revealed that long-term use was associated with receiving a supply of 20 days or more in the initial opioid prescription compared with receiving less than 5 days’ supply (OR, 28.94; 95% CI, 23.44-35.72) and visiting 3 or more prescribers in the 90 days after injury compared to those visiting just 1 prescriber (OR, 14.91; 95% CI, 12.15-18.29). 



Additionally, investigators found that 5 to 9 days’ supply was associated with an increase in the odds of long-term use compared with less than 5 days’ supply (OR, 1.83; 95% CI, 1.56-2.14).

This study, titled “Prevalence and Risk Factors Associated With Long-term Opioid Use After Injury Among Previously Opioid-Free Workers,” is published in JAMA Network Open.