If a patient typically fills opioid (narcotic pain medication) prescriptions monthly, but it has been 6 weeks since the last fill, will the 30-day average medication use still be reflected, while the current day's use would be zero?

From the Guidelines

If someone typically fills opioid prescriptions monthly but hasn't filled one in 6 weeks, their 30-day average would still show their typical usage pattern, but their current daily usage would be zero. This discrepancy occurs because the 30-day average calculation looks backward from the current date, capturing their previous medication use pattern 1. However, since they haven't filled their prescription for 6 weeks (42 days), they would have no current supply and therefore zero current daily usage. This situation could indicate several possibilities:

• the patient may have stopped needing pain medication,
• found alternative pain management strategies,
• obtained medication from another source,
• or potentially be experiencing withdrawal if they were physically dependent 1. From a monitoring perspective, this pattern might warrant follow-up to ensure appropriate pain management and to rule out concerning scenarios such as diversion or misuse 1. Understanding both the average usage pattern and current usage status provides a more complete picture of a patient's medication adherence and needs. It's also important to consider the risks associated with discontinuation of long-term opioid therapy, including adverse events such as mental health crisis, overdose events, and overdose death 1. Therefore, it's crucial to approach this situation with caution and consider the potential consequences of sudden discontinuation of opioid therapy.

From the Research

Opioid Withdrawal Symptoms and Management

• Opioid withdrawal symptoms are a key driver behind continued opioid use, and a barrier to opioid discontinuation 2.
• Physical dependence is responsible for the distressing withdrawal symptoms individuals experience upon abrupt cessation or rapid dose reduction of exogenous opioids 2.
• Opioid withdrawal symptoms were reported by 85% of participants in the last 6 months, with 29% reporting at least monthly withdrawal symptoms and 35% reporting at least weekly withdrawal symptoms 3.

Opioid Use and Withdrawal

• Regular opioid use leads to tolerance and physical dependence, which are predictable, physiologic responses to repeated opioid exposure 2.
• Opioid use disorder (OUD) is a complex, primary, chronic, neurobiological disease rooted in genetic, environmental, and psychosocial factors 2.
• Any opioid withdrawal and weekly or more opioid withdrawal frequency are independently associated with receptive syringe sharing and nonfatal overdose 3.

Management of Opioid Withdrawal Symptoms

• Treatment of withdrawal symptoms is urgently needed and should include buprenorphine dispensing 3.
• Non-opioid medications can provide a gateway into long-term treatment with naltrexone or psychosocial therapies 4.
• α-2 adrenergic agonists can facilitate opioid tapering for opioid-dependent patients without OUD 4.
• Appropriate clinical management of opioid withdrawal is a crucial bridge to long-term treatment for opioid use disorder (OUD) 5.

Calculating Opioid Use

• If someone typically fills opioids monthly but it has been 6 weeks since the last fill, the 30-day average would still be calculated, but the current day would be zero, as there has been no opioid use in the last 30 days. However, there is no direct evidence in the provided studies to support this calculation.