New Study Finds More Than Half of Patients Prescribed Opioids Still on Them Five Years Later

A new study published online July 13 Journal of General Internal Medicine reveals that more than half of the people taking opioids for chronic pain are likely to still be taking the painkillers five years later.

Co-authored by researchers from University of Arkansas for Medical Sciences, University of Washington and HealthCore Inc., the article, “Long-Term Opioid Therapy Discontinuation Rates from the TROUP Study,” examined populations using both Medicaid and private insurance over a five-year period.

Opioids, including morphine, codeine, and oxycodone, among others, are commonly prescribed by physicians to alleviate their patients’ pain. But little is known about how long-term use of opioid painkillers leads to physical dependence and addiction.

Other research studies have shown that opioid prescription drug abuse is the fastest growing form of drug abuse in the United States. The 2009 National Survey on Drug Use and Health (NSDUH), U. S. Department of Health and Human Services, Substance Abuse and Mental Health Services (SAMHSA), found that in 2009, of the 7.1 million persons aged 12 and older classified with dependence on or abuse of illicit drugs, 1.9 million were classified with dependence on or abuse of pain relievers. That makes pain relievers the second most prevalent abused drug behind marijuana
In this study, lead author Bradley Martin, head of the Division of Pharmaceutical Evaluation and Policy for the University of Arkansas for Medical Sciences, said the results “raise the question of whether chronic opioids become a friend for life. When physicians prescribe opioids, they may not always be thinking of these drugs as a form of chronic long-term pain management that often persists for many years.”

The TROUP study covered 23,419 people with private insurance and 6,848 people who were enrolled in Arkansas Medicaid, used medical and pharmacy claims from January 2000 through December 2005. Excluded from the study were people who had filled opioid prescriptions if they were in hospice or long-term care and if they were diagnosed with cancer, other than non-melanoma skin cancer.
The study found that people who were most likely to continue using opioids (beyond the initial 90 days) were those who had been exposed to them before, were prescribed opioid doses higher than 120 milligrams morphine equivalent (MED), and/or possibly misused opioids.

The study determined “misuse” by considering such factors as excess days supplied of opioid and multiple opioid prescribers and multiple opioid pharmacies, all of which may reflect doctor-shopping on the part of the patients.
Significantly, there was “very little difference in long-term use and potential misuse among the two different populations that were studied,” said Andrea DeVries, HealthCore research operations director. She said that the strength of this study is in the inclusion of both the Medicaid population and commercially insured members. This “helps show that the results can be generalized across populations.”

The TROUP study was funded in part through a grant by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH).

Authors of the TROUP study include: Bradley C. Martin, College of Pharmacy, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences; Ming Yu Fan, Department of Psychiatry and Behavioral Sciences, Division of Consultation-Liaison Psychiatry, University of Washington; Mark Edlund, Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences; Andrea DeVries, HealthCore; Jennifer Brennan Braden, Department of Psychiatry and Behavioral Sciences, Division of Consultation-Liaison Psychiatry, University of Washington and Mark Sullivan, Department of Psychiatry and Behavioral Sciences, Division of Consultation-Liaison Psychiatry, University of Washington.