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Publication Briefs

Study Suggests Link between Length of Prescription for Initial Exposure to Opioids and Long-Term Use

Opioid prescribing has changed in the United States in recent years, peaking in 2012. Since then, the incidence of new long-term opioid use has decreased in the VA healthcare system. This decrease reflects changes in attitudes about and policies governing opioid use in general, and long-term opioid use in particular. However, further investigation is needed to better understand the pathways to long-term opioid prescribing. Therefore, this study examined the association between initial opioid exposure and subsequent long-term use in two national VA cohorts from 2011 and 2016. Using VA data, investigators identified incident opioid users during 2016 (n=317,367 Veterans). Incident use was defined as the first prescription for a non-injectable dosage form of a schedule II opioid, tramadol, or codeine during this period, which was preceded by 365 days with no prescriptions for any of these medications. A secondary cohort was constructed for incident opioid users during 2011 (n=376,140). Investigators examined the relationships between days' supply, daily dose, and number of fills within the first 30 days and subsequent long-term opioid use.


  • There is a strong relationship between initial opioid exposure and the future likelihood for long-term use. Cumulative days' supply of prescription opioids emerged as the strongest predictor of long-term opioid use, which occurred in only 2% of Veterans dispensed ≤7 days' supply, and in 28% of patients dispensed >30 days' supply.
  • Comparing 2011 and 2016 data, the association between day's supply and long-term use persisted, even as the overall rate of long-term opioid use decreased.


  • These findings suggest that limiting initial opioid exposure may reduce risk for long-term opioid use. Moreover, examination of early opioid exposure may offer an opportunity to recognize when a patient is in the process of starting long-term opioid use.


  • VA administrative data do not include any outside prescriptions or illegal obtainment of opioids.
  • Examining prescriptions is not a guarantee that patients took medications as prescribed.

This study was funded through HSR&D. All authors are part of HSR&D's Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa.

PubMed Logo Hadlandsmyth K, Lund B, and Mosher H. Associations between Initial Opioid Exposure and the Likelihood for Long-Term Use. Journal of the American Pharmacists Association. November 5, 2018;epub ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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