In this study, research shows that a link between physicians' opioid prescription patterns and following abuse has occupied the attention of a nation in the throes of an opioid. Most clinical efforts have focused on minimizing risk through dosage management. This study shows that among surgery patients with no history of recent or chronic opioid use how long a person takes the drugs for is a more potent predictor of abuse and overdose than how much medication a patient takes. The study published in BMJ.

The findings provide much-needed insight and nuance into the complex dynamic that may fuel opioid misuse, the researchers said. The results, they added, could help inform field-specific guidelines for a medical specialty that, more than any other, relies on opioid pain management. Indeed, research shows that surgery patients are four times more likely than other patients to receive opioids.

Denis Agniel said, "Our results indicate that each additional week of medication use, every refill is an important maker of risk for abuse or dependence.” Over the past 15 years, the rates of opioid overdose in the United States have tripled. Opioid overdoses now rank as a leading cause of nonintentional death, and most of these deaths can be traced back to an initial prescription opioid.

Previous research suggests that between 3 percent and 10 percent of patients who receive opioids for the first time go on to become chronic users. In the new study, none of the 560,000 patients had a record of chronic or extended opioid use leading up to surgery.

For the purposes of the research, patients were deemed non- opioid users if they had not taken opioids in the two months prior to their surgery, or if they had used opioids for fewer than seven days prior to their procedure. Of the more than half million patients, 0.6 percent, or 5,906, developed dependence, symptoms of abuse or experienced a nonfatal overdose collectively defined as opioid misuse.

Each additional week of opioid use increased the risk for dependence, abuse or overdose by 20 percent. Each additional refill boosted the risk by 44 percent, the analysis showed, with the first refill more than doubling the risk. Present guidelines on opioid pain management are generic and do not address specific patient populations.

The new findings, however, suggest that clinical context matters, and that opioid decision making should vary with the context. Isaac Kohane said, "As physicians, we face a dilemma with each opioid prescription, so we need a more nuanced understanding of how to weigh the risks and benefits of opioid pain management immediately after surgery, including factors that influence misuse."