Can Opioids Become a Friend for Life?

LITTLE ROCK, Ark. and WILMINGTON, Del., Aug. 1, 2011 /PRNewswire/ -- More than half the people who take opioids for chronic pain are likely to still be taking the painkillers five years later, according to a new study published online July 13 in the Journal of General Internal Medicine.

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

Opioids – such as morphine, codeine, and oxycodone – are commonly prescribed to alleviate pain, however little it is known about how often long-term use leads to physical dependence and addiction.  Other studies have found that prescription opioid abuse is the fastest growing form of drug abuse, however there is controversy regarding the level of risk for dependence in the general population.

"The results of our study raise the question of whether chronic opioids become a friend for life," said lead author Bradley Martin, head of the Division of Pharmaceutical Evaluation and Policy for the University of Arkansas for Medical Sciences. "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."

People in the study who were most likely to continue using opioids (beyond the initial 90 days) were those who had been exposed to them before, were prescribed doses of opioids higher than 120 milligrams morphine equivalent (MED) and/or possibly misused opioids, according to the study.

"Other than these factors, our study determined that it was difficult to predict which patients were more likely to stay on opioids long term, which makes it challenging for physicians to determine who is more likely to stay on opioids or potentially misuse them," Martin said. "The next step is to determine whether long-term use of opioids can provide necessary pain relief without causing side effects or addiction."

About one in seven people using chronic opioid therapy potentially misuse opioids, according to the study. The study determined "misuse" by considering such factors as excess days supplied of opioid and multiple opioid prescribers and multiple opioid pharmacies, which may reflect doctor shopping.

"We found 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. "Including both the Medicaid population and commercially insured members is a strength of this study, and helps show that the results can be generalized across populations."

The study, covering 23,419 people with private insurance and 6,848 people enrolled in Arkansas Medicaid, used medical and pharmacy claims from January 2000 through December 2005. The study excluded people who had filled prescriptions for opioids if they were in long-term or hospice care and if they were diagnosed with cancer other than non-melanoma skin cancer.

The TROUP study was funded through a grant by the National Institute on Drug Abuse, which is part of the National Institutes of Health. The TROUP study was authored by:  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.

About University of Arkansas for Medical Sciences

The University of Arkansas for Medical Sciences is the state's only comprehensive academic health center, with colleges of Medicine, Nursing, Pharmacy, Health Related Professions and Public Health; a graduate school; a 540,000-square-foot hospital; a statewide network of regional centers; and six institutes: the Winthrop P. Rockefeller Cancer Institute, the Jackson T. Stephens Spine & Neurosciences Institute, the Myeloma Institute for Research and Therapy, the Harvey & Bernice Jones Eye Institute, the Psychiatric Research Institute and the Donald W. Reynolds Institute on Aging. It is the only adult Level 1 trauma center in the state. UAMS has 2,836 students and 761 medical residents. It is the state's largest public employer with more than 10,000 employees, including nearly 1,150 physicians who provide medical care to patients at UAMS, Arkansas Children's Hospital, the VA Medical Center and UAMS' Area Health Education Centers throughout the state. Visit www.uams.edu or www.uamshealth.com.

About HealthCore, Inc.

HealthCore, based in Wilmington, Del., is the clinical outcomes research subsidiary of WellPoint, Inc.  HealthCore has a team of highly experienced researchers including physicians, biostatisticians, pharmacists, epidemiologists, health economists and other scientists who study the "real world" safety and effectiveness of drugs, medical devices and care management interventions. HealthCore offers insight on how to best use this data and communicates these findings to health care decision-makers to support evidence-based medicine, product development decisions, safety monitoring, coverage decisions, process improvement and overall cost-effective health care. For more information, go to www.healthcore.com.

SOURCE HealthCore, Inc.