Opioid Prescribing for Acute Pain: Taking It to the Limit

Nicholas J. Gross, MD, PhD


September 26, 2018

A perspective addressing opioid prescribing strategies to help combat the opioid epidemic was recently published in the New England Journal of Medicine.[1]

Nearly one half of the US states have adopted limits to the amount of opioids that can be prescribed for acute pain. Some states specify the number of days' worth that can be prescribed or set a maximum dose that can be dispensed. Although there is no national standard for the duration and dosage of an opioid for a patient with a recent bona fide temporary disorder, a national standard for such limits has been proposed. However, these limits would not be applicable to patients with chronic pain or cancer, or those who are already addicted.[1]

So, how likely is a patient who receives an opioid for transient pain to become addicted? Of new opioid users, about 6% continued to use opioids at 1 year.[2] Furthermore, "the chances of chronic use begin to increase after the third day supplied…"[2]

Of interest, one study showed that a large percentage of people who misuse opioids receive them from friends or relatives—bypassing physicians.[3]

The authors of this perspective suggest that there is a need for "strategies to encourage the use of nonopioid alternatives, discontinuation of opioids after acute pain episodes, and disposal of leftover pills."[1]

They also put forth the recommendation that "a 3-day supply will be sufficient for most opioid prescriptions for acute pain"-but add that a 3-day limit is likely to be too restrictive for the most severe indications.[1]

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