Long-term opioid use in the United States: prescribing patterns, dose intensity, and policy impact in chronic non-cancer pain-a systematic review

Younes, Dana Bani and Ahmad Mizher, Hussam Abdeljabar and Arabyat, Shahed and Zin, Che Suraya (2026) Long-term opioid use in the United States: prescribing patterns, dose intensity, and policy impact in chronic non-cancer pain-a systematic review. Trends in Anaesthesia and Critical Care, 71 (1). pp. 1-13. ISSN 2210-8440 E-ISSN 2210-8467

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Abstract

Objectives: This systematic review aims to evaluate the prevalence, prescribing patterns, and factors associated with long-term use, as well as policy implications of long-term opioid therapy (LTOT) among patients with chronic non-cancer pain (CNCP) in the United State. Methods: A systematic search was conducted, including comprehensive literature searches of Medline-PubMed, Cochrane Library, and SCOPUS databases for studies conduct in United State. Eligible studies published between 2015 and 2025 with cohort, cross-sectional, randomized controlled trial, and quasi-experimental designs were included. LTOT was established as the use of opioids for ≥90 consecutive days or an equivalent study-specific definition. The quality of studies was assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Findings were synthesized narratively due to heterogeneity. No formal assessment of reporting bias was undertaken, and certainty in the body of evidence was not assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. This systematic review was not prospectively registered, and no formal review protocol was prepared. Results: Out of 1288 records, 15 studies met the predefined inclusion criteria. Overall methodological quality was high; however, substantial heterogeneity was observed in study design, chronic pain definitions, and operational criteria for LTOT. Across general adult populations with non-cancer pain, the prevalence of LTOT ranged from 3.0% to 15.9%, with higher rates observed among older adults with chronic pain and patients with chronic comorbid conditions. Among Veterans Health Administration (VHA) patients with chronic low-back pain, the proportion who filled an opioid prescription decreased from 21.1% to 16.0%, while the mean daily opioid dose decreased from 25.4 to 18.1 MME/day Among privately insured adults with CNCP, the proportion receiving any opioid prescription decreased from 49.7% in 2012 to 30.5% in 2019. Among opioid-naïve adults, 26.1% filled a prescription, but only 3.0% progressed to long-term use. Opioid dose intensity was generally low to moderate, with a mean daily dose of 38.7 mg, although a subgroup of patients received high-dose therapy (≥90 MME/day). Among high-dose users (≥50 MME/day), 26.7% tapered, 9.3% discontinued, while rapid tapering occurred in up to 72% of discontinuation episodes. Prescribing patterns varied by demographic, clinical, provider, and geographic factors. Policy and system-level interventions were generally associated with reductions in opioid prescribing practices. LTOT affects a minority of U.S. adults but represents a clinically important subgroup with higher exposure and risk, alongside substantial variability in prevalence, dosing, tapering, and policy responsiveness. Conclusions: Long-term opioid use in the U.S. declined in response to policy and guideline changes; however, persistent variability in prescribing, dosing, and tapering practices highlights the need for standardized definitions and targeted strategies to optimize opioid management.

Item Type:	Article (Review)
Subjects:	R Medicine > RM Therapeutics. Pharmacology R Medicine > RM Therapeutics. Pharmacology > RM300 Drugs and their action
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Pharmacy Kulliyyah of Pharmacy > Department of Basic Medical Sciences Kulliyyah of Pharmacy > Department of Pharmacy Practice
Depositing User:	Dr Hussam Abdeljabar Mizher
Date Deposited:	15 Oct 2026 12:55
Last Update:	15 Oct 2026 12:55
Queue Number:	2026-10-Q5678
URI:	http://irep.iium.edu.my/id/eprint/132027
Indexed In:	WOS and SCOPUS, Google Scholar

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