Patterns of initial opioid prescription and its association with short-term and long-term use among opioid-naïve patients in Malaysia: a retrospective cohort study

Abstract

ObjectiveThis study examined opioid prescription initiation patterns and their association with short-term and long-term opioid use among opioid-naïve patients.DesignThis study was designed as a retrospective cohort study.Setting and participantsIn this study, we analysed the prescription databases of tertiary hospitals in Malaysia. This study included patients aged ≥18 years with at least one opioid prescription (buprenorphine, morphine, oxycodone, fentanyl, dihydrocodeine or tramadol) between 1 January 2011 and 31 December 2016. These patients had no opioid prescriptions in the 365 days prior, and were followed up for 365 days after the initial opioid prescription.Main outcome measuresThe main outcome measures were the number of short-term (<90 days) and long-term opioid users (≥90 days), initial opioid prescription period and daily dose.ResultsThere were 33 752 opioid-naïve patients who received opioid prescriptions (n=43 432 prescriptions) during the study period. Of these, 29 824 (88.36%) were short-term opioid users and 3928 (11.64%) were long-term opioid users. The majority of these short-term (99.09%) and long-term users (96.18%) received an initial daily opioid dose of <50 mg/day with a short-acting opioid formulation. Short-term opioid users were predominantly prescribed opioids for 3–7 days (59.06%) by the emergency department (ED, 60.56%), while long-term opioid users were primarily prescribed opioids for ≥7 days (91.85%) by non-ED hospital departments (91.8%). The adjusted model showed that the following were associated with long-term opioid use: increasing opioid daily doses, prescription period ≥7 days and long-acting opioids initiated by non-EDs.ConclusionsThe majority of opioid-naïve patients in tertiary hospital settings in Malaysia were prescribed opioids for short-term use. The progression to long-term use among opioid-naïve patients was attributed to the prescription of higher opioid doses for a longer duration as well as long-acting opioids initiated by non-ED hospital departments.

Variations in Long‐term Opioid Therapy Definitions: A Systematic Review of Observational Studies Using Routinely Collected Data (2000‐2019)

“…One‐fifth of studies included only opioid‐naïve individuals (29 studies), mostly defined as the absence of opioid use in the 6 24,36,37,52,65,69–73 or 12 months 30,48,61,62,74–83 prior to the index date. Some studies investigated opioid use among patients with various specific health conditions: 43 studies 24,26–28,31,37,43,48,49,51,52,59,62,65,70,74,77–80,82–104 focused on noncancer pain, 14 studies 55,56,64,69,105–114 on musculoskeletal conditions, 13 studies 38–40,57,81,115–122 on injuries or trauma and eight studies 23,32,53,67,75,123–125 on infectious diseases. Seven studies 41,44,45,71,126–128 included patients with both cancer and noncancer pain, and six studies evaluated patients with cancer 60,129,130 or cancer survivors 61,131,132 .…”

“…Overlapping opioid prescriptions (ie, prescriptions filled on the same day or before the end of supply of the prior prescription) were addressed in 24 studies (19%). Twelve studies 37,54,55,61,68,73,83,97,101,128,134,135 carried forward supplies occurring before the prior prescription ended (ie, shifted the fill date forward to the day after the end of supply of the previous fill), of which seven studies carried forward supplies for a specific number of overlapping days (eg, <10 days or 20% of overlapping) 122,136,137 . The remaining 12 studies considered overlapping prescriptions as concurrent use 37,54,55,61,68,73,83,97,101,128,134,135 …”

Surgeon Postoperative Opioid Prescribing Intensity and Risk of Persistent Opioid Use Among Opioid-naive Adult Patients

“…11,21 Similarly, the relationship between provider opioid prescribing practice patterns, including provider rate of opioid prescribing and the duration and dose of initial prescription, has been examined across several patient populations with generally conflicting results. 3,9,[24][25][26] In their study of the prescribing practice of emergency department physicians, Barnett et al 9 provide evidence that high-intensity FIGURE 1. Median daily dose of opioids (MMEs) and interquartile range of all prescriptions filled in first 7 days after surgery.…”

Real-world patterns of opioid therapy initiation in Spain, 2012–2018: A population-based, retrospective cohort study with 957,080 patients and 1,509,488 initiations

“…However, comparative research into the factors driving opioid use and misuse and related harm in Europe is lacking. For instance, most studies specifically describing the patterns of opioid initiation in non-cancer pain come from the US ( Dobscha et al, 2013 ; Kern et al, 2015 ; Deyo et al, 2017 ; Shah et al, 2017 ; Mundkur et al, 2018 ; Larach et al, 2020 ; Hadlandsmyth et al, 2022 ; Weiner et al, 2022 ), some from other countries ( Zin et al, 2019 ; Jani et al, 2020 ; Gomes et al, 2021 ; Pilarinos et al, 2022 ) and virtually none from Europe. In this sense, our study provides very much needed information about specific patterns of initiation with different opioid agents for a vast number of non-cancer indications, with rich individual and contextual information, and depicts different profiles of patients exposed to opioids.…”