Opioids after acute musculoskeletal injuries in adults – what predicts ongoing use?

A systematic review has examined factors associated with persistent opioid use after prescribing for acute musculoskeletal injury. Studies involving 263 393 participants were included, and the overall prevalence of prolonged opioid use after musculoskeletal injury for high-risk populations (defined as patients receiving workers’ compensation benefits, Veterans Affairs claimants, or patients with high rates of concurrent substance use disorder) was found to be 27% (95% CI, 18% to 37%). Among low-risk populations the prevalence was 6%. Moderate-certainty evidence suggests that there are increased odds of persistent opioid use with older age (absolute risk increase [ARI] for every 10-year increase, 1.1% [CI, 0.7% to 1.5%]) and physical comorbidity (ARI, 0.9% [CI, 0.1% to 1.7%]), whereas low-certainty evidence suggested increased risk for persistent opioid use with past or current substance use disorder (ARI, 10.5% [CI, 4.2% to 19.8%]), prescriptions lasting more than 7 days (median ARI, 4.5%), and higher morphine milligram equivalents per day. Despite the weaker nature of the evidence, the authors suggest that it would be best to avoid prescribing opioids for acute musculoskeletal injuries to patients with past or current substance use disorder, and restricting duration to 7 days or less and using lower doses when they are prescribed. It seems sensible to add a note of caution about prescribing opioids for older people as well. Read more here.