#240 What is the Incidence of Iatrogenic Opioid Use Disorder?
CLINICAL QUESTION
What is the risk of developing opioid use disorder (OUD) when taking prescription opioids?
BOTTOM LINE
The incidence of OUD associated with prescribed opioids among chronic pain patients is likely ~3% (over ~2 years) but causation is uncertain. Patients with no history of substance use disorders appear to be at lower risk (<1%). Factors associated with increased risk of OUD include a history of substance use disorder and receiving opioids for longer duration (>90 days) or at higher doses (>120mg/day morphine equivalent).
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EVIDENCE
- Systematic review1 (12 studies, 310,408 patients): Pain patients prescribed opioid therapy (≥7 days and 97% had ≥3 months).
- Incidence of opioid dependence or “abuse” was 3.1% in higher quality studies.
- 4.7%, if all studies included.
- Diagnostic criteria matter: incidence varies (from 1-11%) with different diagnostic criteria.
- Incidence of opioid dependence or “abuse” was 3.1% in higher quality studies.
- Systematic review2 (24 studies, 2507 patients): chronic pain patients prescribed opioid therapy, average exposure 26 months (range: 2-240).
- Incidence of opioid addiction was 3.3%
- 0.2% in patients without a history of “substance abuse/addiction” versus 5% with positive history.
- Limitations: Varying addiction definitions; quality of trials included: retrospective (71%), prospective and/or randomized (29%); unclear pooling technique.
- Incidence of opioid addiction was 3.3%
- Two systematic reviews:3,4 incidence 0.3%-0.5% but generally lower risk patients.3,4
- Incidence: new cases of OUD after opioid prescription and may better estimate latrogenic OUD than prevalence. Prevalence: all OUD patients, including those who obtained prescribed opioids after developing OUD.2
- Prevalence of OUD ranges from 0.05%-23%.3, 5-10
- Wide variation attributable to differing study quality, variable diagnostic criteria/terminology, inconsistent reporting, and populations studied.
- Majority of included studies (using terms like “addiction” or “substance abuse”) published before DSM-V criteria.
- Exposure to prescription opioids in adolescents and young adults was associated with future non-medical prescription opioid use11 and OUD.12
- From one insurance database cohort study (568,640 patients), after 12 months:13
- Duration: For doses 36-120mg/day morphine equivalent, OUD incidence with acute use (1-90 days) was 0.12% versus 1.3% with chronic use (prescriptions >90 days).
- Dose: For prescriptions >90 days, OUD incidence with 1-36mg/day morphine equivalents was 0.7% versus 6.1% with >120mg/day morphine equivalent.
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