By Brian Zimmerman

While most clinical efforts to mitigate the risk of opioid misuse have focused on limiting dosage levels, reducing the length of an opioid prescription actually has greater influence over the risk of misuse, according to a study published in BMJ.

For the study, researchers examined the health records of more than 568,612 privately insured patients nationwide who filled an opioid prescription postoperatively between 2008 and 2016. The patients had no history of opioid misuse prior to surgery. Researchers identified misuse in 5,906 patients via a diagnostic code indicating opioid dependence, abuse or overdose.

Analysis revealed the risk of misuse increased 20 percent with each additional week of opioid use and 44 percent with each additional prescription refill. Additionally, researchers found dosage — the amount of opioids taken over a 24-hour period — had minimal correlation to the risk of misuse when compared to prescription length. For patients taking opioids for two weeks or less, the risk of misuse was not influenced by dosage levels, even when the dose was twice as high. However, high opioid dosage did display a significant correlation to misuse in patients taking opioids for nine weeks or more.

“We are in the midst of an epidemic, and physician prescription practices play no small part in it,” said Nathan Palmer, PhD, a biomedical informatics researcher at Harvard Medical School in Boston and one of the study’s authors. “Understanding differences in risk for opioid misuse across various patient populations and clinical contexts is critical in informing the creation of narrowly tailored guidelines, clinical decision making and the national conversation on this topic.”

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