@article {B{\'e}liveauE96, author = {Audrey B{\'e}liveau and Anne-Marie Castilloux and Cara Tannenbaum and Philippe Vincent and Cristiano Soares de Moura and Sasha Bernatsky and Yola Moride}, title = {Predictors of long-term use of prescription opioids in the community-dwelling population of adults without a cancer diagnosis: a retrospective cohort study}, volume = {9}, number = {1}, pages = {E96--E106}, year = {2021}, doi = {10.9778/cmajo.20200076}, publisher = {Canadian Medical Association Open Access Journal}, abstract = {Background: Long-term opioid use is a known risk factor for opioid-related harms. We aimed to identify risk factors for and predictors of long-term use of prescription opioids in the community-dwelling population of adults without a diagnosis of cancer, to inform practice change at the point of care.Methods: Using Quebec administrative claims databases, we conducted a retrospective cohort study in a random sample of adult members (>= 18 yr) of the public drug plan who did not have a cancer diagnosis and who initiated a prescription opioid in the outpatient setting between Jan. 1, 2012, and Dec. 31, 2016. The outcome of interest was long-term opioid use (>= 90 consecutive days or >= 120 cumulative days over 12 mo). Potential predictors included sociodemographic factors, medical history, characteristics of the initial opioid prescription and prescriber{\textquoteright}s specialty. We used multivariable logistic regression to assess the association between each characteristic and long-term use. We used the area under the receiver operating characteristic curve to determine the predictive performance of full and parsimonious models.Results: Of 124 664 eligible patients who initiated opioid therapy, 4172 (3.3\%) progressed to long-term use of prescription opioids. The most important associated factors in the adjusted analysis were long-term prescription of acetaminophen{\textendash}codeine (odds ratio [OR] 6.30, 95\% confidence interval [CI] 4.99 to 7.96), prescription of a long-acting opioid at initiation (OR 6.02, 95\% CI 5.31 to 6.84), initial supply of 30 days or more (OR 4.22, 95\% CI 3.81 to 4.69), chronic pain (OR 2.41, 95\% CI 2.16 to 2.69) and initial dose of at least 90 morphine milligram equivalents (MME) per day (OR 1.24, 95\% CI 1.04 to 1.47). Our predictive model, including only the initial days{\textquoteright} supply and chronic pain diagnosis, had area under the curve of 0.7618.Interpretation: This study identified factors associated with long-term prescription opioid use. Limiting the initial supply to no more than 7 days and limiting doses to 90 MME/day or less are actions that could be undertaken at the point of care.}, URL = {https://www.cmajopen.ca/content/9/1/E96}, eprint = {https://www.cmajopen.ca/content/9/1/E96.full.pdf}, journal = {Canadian Medical Association Open Access Journal} }