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De Facto Long-term Opioid Therapy for Noncancer Pain

Korff, Michael Von ScD*; Saunders, Kathleen JD*; Thomas Ray, Gary MBA; Boudreau, Denise PhD*; Campbell, Cynthia PhD; Merrill, Joseph MD, MPH§; Sullivan, Mark D. MD, PhD; Rutter, Carolyn M. PhD*; Silverberg, Michael J. PhD, MPH; Banta-Green, Caleb MSW, MPH; Weisner, Constance Dr PH, MSW† ¶

Clinical Journal of Pain:
doi: 10.1097/AJP.0b013e318169d03b
Original Articles
Abstract

Objectives: This paper describes characteristics of opioid use episodes for noncancer pain and defines thresholds for de facto long-term opioid therapy.

Methods: CONSORT (CONsortium to Study Opioid Risks and Trends) includes adult members of 2 health plans serving over 1% of the US population. Opioid use episodes beginning in the years 1997 to 2005 were classified as acute, episodic, long-term/lower dose, or long-term/higher dose.

Results: On the basis of evaluation of the likelihood of opioid use continuing, long-term opioid therapy was defined by episodes lasting longer than 90 days with 10+ opioid prescriptions or 120+ days supply of opioids dispensed. Long-term/higher dose episodes (<1.5% of all opioid use episodes) were characterized by daily or near daily use, a mean duration of about 1000 days, and an average daily dose of about 55 mg. They accounted for more than half the total morphine equivalents dispensed from the years 1997 to 2006. Short-acting, non-Schedule II opioids (eg, hydrocodone with acetaminophen) were, by far, the most commonly prescribed medications for acute, episodic, and long-term episodes. Long-acting (sustained-release) opioids were the predominately prescribed medication in a minority of long-term episodes (6% to 12%).

Discussion: Long-term opioid therapy was characterized by the diversity in medications prescribed, dosage levels, and frequency of use. The proposed threshold for long-term opioid therapy provides a checkpoint for physicians to review whether an explicit decision to sustain opioid therapy has been reached, and to ensure that a documented treatment plan and provisions for monitoring medication use and patient outcomes are in place.

Author Information

*Center for Health Studies, Group Health Cooperative

Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine

§Department of Medicine, University of Washington School of Medicine

Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA

Division of Research, Kaiser Permanente of Northern California, 2000 Broadway, Oakland

Department of Psychiatry, University of California, San Francisco, CA

Supported by NIDA Grant R01 DA022557.

Reprints: Dr Michael Von Korff, ScD, Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101 (e-mail: Vonkorff.m@ghc.org).

Received for publication November 12, 2007; revised January 15, 2008; accepted January 17, 2008

© 2008 Lippincott Williams & Wilkins, Inc.