An updated view on the influence of initial opioid prescription characteristics on long-term opioid use among opioid naïve patients

Objectives: This retrospective cohort study provides an updated view on the association between the likelihood of long-term opioid use (LTOU) and characteristics of the initial opioid prescription (dose, opioid type) and initial opioid prescription episode (days' supplied) among opioid-na & iuml;ve patients utilizing IQVIA PharMetrics (R) Plus for Academics database representative of commercially insured patients in the US. Methods: Kaplan-Meier estimates were used to determine opioid continuation likelihood at 365 days stratified by the characteristics of the initial opioid prescription and initial opioid prescription episode. Cox-proportional hazard models were estimated to determine the strength of association between initial opioid prescription characteristics and opioid continuation. Results: A total of 578,403 cancer-free, SUD-free, opioid-na & iuml;ve subjects aged >= 14 years that filled >= 1 opioid prescriptions between April 13, 2016 and April 18, 2020 were identified and categorized based on time to opioid discontinuation. After accounting for censoring, 5.05 % of persons continued opioid use for >= 365 days. Compared to a 1-2 days' supply (DS), the likelihood of opioid discontinuation was consistently lower with higher DS [HRs (CIs): 3-4 days' supply = 0.66 (0.65-0.66); 5-7 DS = 0.41 (0.41-0.41); 8-10 DS = 0.33 (0.33-0.34); 11-14 DS = 0.30 (0.29-0.31); 15-21 DS = 0.26 (0.26-0.27); >= 22 DS = 0.17 (0.17-0.18)]. These associations between increased DS and decreased likelihood of discontinuing opioid remained consistent across different pain etiologies. Conclusions: In this era of more conservative opioid prescribing, increases in DS remains the strongest factor associated with a higher likelihood of LTOU.