title: Long-term pattern of opioid prescriptions after femoral shaft fractures.
abstract: BACKGROUND
  The use of opioids in non-cancer-related pain following skeletal trauma is controversial due to the presumed risk of dose escalation and dependence. We therefore examined the pattern of opioid prescriptions, that is, those actually dispensed, in patients with femoral shaft fractures.
  
  
  METHODS
  We analysed data from the Swedish National Hospital Discharge Register and the Swedish Prescribed Drug Register between 2005 and 2008.
  
  
  RESULTS
  We identified 1471 patients with isolated femoral shaft fractures. The median age was 75 (16-102) years and 56% were female. In this cohort, 891 patients (61%) received dispensed opioid prescriptions during a median follow-up of 20 months (interquartile range 11-32). In the age- and sex-matched comparison cohort (7339 individuals) without fracture, 25% had opioid prescriptions dispensed during the same period. The proportions of patients receiving opioid analgesics at 6 and 12 months after the fracture were 45% (95% CI 42-49) and 36% (32-39), respectively. The median daily morphine equivalent dose (MED) was between 15 and 17 mg 1-12 months post-fracture. After 3 months, less than 5% used prescription doses higher than 20 mg MED per day. Older age (≥ 70 compared with < 70 years) was a significant predictor of earlier discontinuation of opioid use (Hazard ratio [HR] 1.9).
  
  
  CONCLUSIONS
  A notable proportion of patients continued to receive dispensed prescriptions for opioids for over 6 months (45%) and more than a third of them (36%) continued treatment for at least 12 months. However, the risk of dose escalation seems to be small in opioid-naïve patients.
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Z
authors.initials: Z
authors.lastname: Al Dabbagh
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: K Å
authors.initials: KÅ
authors.lastname: Jansson
authors.affiliation: Department of Medicine, Clinical Pharmacology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: C O
authors.initials: CO
authors.lastname: Stiller
authors.affiliation: Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.|Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.|Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Montgomery
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: R J
authors.initials: RJ
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015331:Cohort Studies; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D005264:Femoral Fractures / Q000150:complications*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid