Long-term opioid therapy reconsidered

In the past 20 years, primary care physicians have greatly increasedprescribing of long-term opioid therapy. However, the rise in opioidprescribing has outpaced the evidence regarding this practice. Increasedopioid availability has been accompanied by an epidemic ofopioid abuse and overdose. The rate of opioid addiction amongpatients receiving long-term opioid therapy remains unclear, butresearch suggests that opioid misuse is not rare. Recent studiesreport increased risks for serious adverse events, including fractures,cardiovascular events, and bowel obstruction, although further researchon medical risks is needed. New data indicate that opioidrelatedrisks may increase with dose. From a societal perspective,higher-dose regimens account for the majority of opioids dispensed,so cautious dosing may reduce both diversion potential and patientrisks for adverse effects. Limiting long-term opioid therapy to patientsfor whom it provides decisive benefits could also reduce risks.Given the warning signs and knowledge gaps, greater caution andselectivity are needed in prescribing long-term opioid therapy. Untilstronger evidence becomes available, clinicians should err on theside of caution when considering this treatment.