Unintended prolonged opioid use: a prospective case–control study

Appropriate short-term use of opioids in opioid-naive adults can result in unintended prolonged opioid use (UPOU) which is associated with significant morbidity and mortality. The objective of this prospective case-control study was to identify incident cases of UPOU and to compare their characteristics with patients who did not progress to UPOU. Opioid-naive adults receiving an initial opioid prescription for surgical or nonsurgical indications were recruited at 3 clinical sites. Patients progressing to UPOU (cases) were identified 90 days after the initial prescription and compared with patients who did not progress to UPOU (controls). The status of opioid use was verified using urine drug tests. The cohort included 513 cases and 517 controls. The mean (SD) patient age was 49.6 (15.3) years and 694 (67.4%) were female. In an adjusted logistic regression analysis, several patient characteristics significantly associated with UPOU included ≥2 emergency department evaluations in the past year; prior spine, joint replacement, or cataract surgery; status as a current or former smoker; daily use of over-the-counter pain medications; opioid craving; and greater pain interference. Conversely, characteristics negatively associated with UPOU included postsurgical pain as the indication for the initial opioid prescription, prior pregnancy, greater widespread body pain, and lower levels of general activity. The findings of this study offer novel insights into the behavioral pain responses and patient characteristics associated with UPOU. These results will be used to promote strategies to identify at-risk patients and to deploy interventions targeting the modifiable risk factors for UPOU.