Reducing Prescription Opioid Dose and Duration to Reduce Risk of Opioid Use Disorder Among Patients With Musculoskeletal Pain.

Background: We estimated the extent to which the risk of developing opioid use disorder or overdose over 15 months of follow-up would be affected by applying prescription opioid dose and duration reductions to subsets of newly diagnosed musculoskeletal pain patients, defined in terms of the "riskiness" level of their initial opioid prescription.

Methods: We studied a cohort of nonpregnant Medicaid patients, aged 19-63 years, without cancer nor on palliative care, who were opioid-naive, newly diagnosed with musculoskeletal pain, and were prescribed an opioid within 3 months from the diagnosis date (N = 324,389). We applied a novel statistical approach to estimate the effects of local modified treatment policies (a generalization of the average treatment effect on the treated). Specifically, we estimated the expected difference in risk of developing opioid use disorder or opioid overdose by sequential 3-month follow-ups among patients with different levels of opioid prescribing had those patients had their prescription opioid dose and/or duration decreased by 20% versus no hypothetical intervention, and had they remained uncensored.

Results: We estimated clinically modest effects on absolute opioid use disorder risk when universally reducing opioid prescription dose and duration by 20% across the cohort. In contrast, we estimated much larger, clinically relevant reductions in absolute risk of one percentage point or greater when assessing the localized effects of: (1) a 20% reduction in dose among individuals with doses ≥90 morphine milligram (mg) equivalents, (2) a 20% reduction in days supplied among individuals with >30 days supplied, and (3) 20% reductions in both dose and duration among those with ≥50 morphine mg equivalents and >7 days supplied.

Conclusions: We estimate that reductions in opioid prescribing may have a limited impact on the risk of opioid use disorder when applied broadly but possibly meaningful reductions in risk when applied to those with riskier prescriptions.