Study: 1 in 48 Who Are Newly Prescribed Opioids Become Long-Term Users

A new study published today in the New England Journal of Medicine casts new light on the severity of the opioid abuse crisis in the United States. Nearly one out of 48 people who are newly prescribed an opioid will become long-term users, the study’s lead author said.

The study findings seem to indicate that the prescribing habits of doctors are a driver of the opioid epidemic. A patient who sees a doctor that often prescribes opioids is at a higher risk for long-term use than a patient who sees a doctor who shies away from the drugs, the data suggest.

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“These are sobering results,” said Michael Barnett, assistant professor of health policy management at Harvard Chan School, in a news release from the school of public health. “Our analysis suggests that one out of every 48 people newly prescribed an opioid will become a long-term user. That’s a big risk for such a common therapy.”

The Centers for Disease Control and Prevention estimate that 15,000 people in the U.S. overdosed on prescription opioids in 2015. The most commonly overdosed opioids included methadone, oxycodone and hydrocodone, the CDC says. Deaths are most common among people ages 25-54 years.

The study looked at emergency room patients, though there are obvious implications for dentists, too.

The prevalence of wisdom-tooth extraction puts dentists in a position where they're prescribing to adolescents, a demographic that's at-risk for hazardous behavior, says Paul A. Moore (D.M.D, PhD, MPH), professor of pharmacology, dental anesthesiology and dental public health at the University of Pittsburgh.

"If that's the first time they've experienced an opioid, I think it gives us a responsibility to counsel those patients," Moore said. "We are in fact prescribing to adolescents and they are a special group that are potentially risk takers that are going to potentially misuse an opioid."

Moore also noted that dentists account for 11-12 percent of all prescriptions of immediate-acting opioids.

At the Yankee Dental Congress last month, David A. Keith (B.D.S., F.D.S.R.C.S., D.M.D.) spoke at length about the dentistry’s role in addressing the opioid epidemic. Keith explained that dentists are the chief opioid prescribers for children and young adults ages 10 to 19. This is troublesome, according to Keith, because 70-80 percent of misused prescription opioids originate as legitimate prescriptions.

In October 2016, the American Dental Association adopted these guidelines for opioid prescription among dentists.

"It gives us an opportunity to be a part of the solution," said Moore.

Researchers involved in the study looked at emergency room visits among a group of Medicare patients between Jan. 1, 2008 and Dec. 31, 2011, a sample size of 215,678 patients. They identified patients among this group who received an opioid prescription, excluding methadone. From there, the researchers determined which study participants became long-term users. They defined long-term users as patients who received “180 days or more of opioids supplied in the 12 months after an index emergency department visit, excluding prescriptions within 30 days after the index visit.” Scrutiny of the data revealed a positive association of doctors who often prescribed opioids with patients who become long-term opioid users over the subsequent year.

This first-of-its-kind study examined the premise that addiction to opioids often starts with a prescription. The results “provide evidence that this mechanism could drive initiation of long-term opioid use through either increased rates of opioid prescription or prescription of a high, versus a low, dose of opioid. … Although causality cannot be established from this observational study, if our results represent a causal relationship, for every 48 patients prescribed a new opioid in the emergency department who might not otherwise use opioids, one will become a long-term user.”

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Joe Hannan, Dentist’s Money Digest managing editor: jhannan@dmdtoday.com