It is rare for a person from a developed country to avoid opiate use. Approx 10% are genetically, and psycho socially predisposed to chemical addictions. It is fascinating to see the difference in CNS effects in this population. In addition to personal family, and 75 yo "prim&proper" patients, almost every opiod prone individual or addict I've spoken w or heard about describe the same effects. Notable thought clarity and stimulation with low-mod dose. In comparison the non-prone note lack of clarity and sedation. I suggest these observations should be studied and possibly used as early warnings for Physician's who prescribe opiates
Chronic Opioid Use More Common with Long-Acting Opioids, Longer Rx Duration — Physician’s First Watch
Chronic Opioid Use More Common with Long-Acting Opioids, Longer Rx Duration
By Kelly Young
Edited by André Sofair, MD, MPH
Authorizing a second opioid prescription in opioid-naive adults doubles the risk for chronic opioid use, according to an MMWR study.
Researchers examined a sample of 1.3 million U.S. adults who were prescribed opioids for the first time between 2006 and 2015. Of these, the probability of continued opioid use 1 year later was 6%, and 3 years later, 3%. Of those who refilled a prescription, roughly 14% were still taking opioids at 1 year. Those given a longer supply in their first prescription also had higher rates of chronic use.
Long-acting opioids and tramadol had the highest probabilities of long-term use (27% and 14% at 1 year). Tramadol was unexpected given its limited affinity for the µ-opioid receptor, the authors note.
They reiterate: "Treatment of acute pain with opioids should be for the shortest durations possible. Prescribing <7 days (ideally ≤3 days) of medication when initiating opioids could mitigate the chances of unintentional chronic use. When initiating opioids, caution should be exercised when prescribing >1 week of opioids or when authorizing a refill or a second opioid prescription ... Prescribers should discuss the long-term plan for pain management with patients for whom they are prescribing either Schedule II long-acting opioids or tramadol."