Exploring the use of extended release opioids at shortened dosing intervals in people with chronic pain and high risk me
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RESEARCH ARTICLE
Exploring the use of extended release opioids at shortened dosing intervals in people with chronic pain and high risk medication or substance use Laura Murphy1 · Bruna Brands2 · Daniel Grant3 · Andrew Smith4 · Maria Zhang5 · Beth Ann Sproule6 Received: 30 December 2019 / Accepted: 3 April 2020 © Springer Nature Switzerland AG 2020
Abstract Background Critical attention to rational opioid prescribing has emerged from the opioid epidemic in North America. Individuals with chronic pain are prescribed extended release opioids in an effort to maintain stable drug levels and for more convenient dosing, though evidence to support improvements in pain or function is lacking. It has been observed that extended release opioid products are used at intervals shorter than recommended by product monographs. The need for shortened intervals has been linked with potential inter-patient variability in pharmacokinetics, among other rationale. Implications of shortened dosing intervals for extended release opioids have not been systematically studied. Objective The aim of this study was to characterize the use of extended release opioid formulations at shortened dosing intervals in a population of patients with chronic pain and high risk for opioid-related harms. Setting This study took place in the Interprofessional Pain and Addiction Recovery Clinic, a specialty ambulatory clinic at the Centre for Addiction and Mental Health in Toronto, Canada for adults with chronic pain and a diagnosis or suspicion of substance use disorder. Method This was a retrospective crosssectional study. Data were collected from records of patients with assessments completed in the years 2012–2017 (n = 210). Main outcome measure Proportion of patients using extended release opioids at shortened intervals. Results Sixty-one percent of individuals using extended release opioids (n = 78) were using them at shortened intervals. This use was associated with a higher daily morphine equivalent dose (533 mg vs 236 mg, p
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