Opioids are commonly prescribed for acute musculoskeletal injuries; however there are high chances of long-term use and consequent harm. This systematic review and meta-analysis of observational studies were aimed to explore the factors associated with continued opioid use after its prescription for acute musculoskeletal injury. The meta-analysis was made using multiple electronic databases, up to January 6th, 2020. Observational studies of adults with opioid prescriptions for acute musculoskeletal injuries explored the risk factors for prolonged use. The studies eligible for the review reported the association of 47 independent variables, three of which were suitable for meta-analysis.
Six reviewers worked in pairs of two, independently extracted data, rated the studies, and evaluated the evidence’s certainty. Fourteen cohorts with 13,263,393 participants were included in this study. The overall prevalence of prolonged opioid use after musculoskeletal injury for high-risk populations was 27%, where that among low-risk populations was 6%. Moderately certain evidence showed increased odds of ongoing opioid use with older age and physical comorbidity. Less certain evidence suggested an increased risk for persistent opioid use with past or current substance use disorder, prescriptions lasting more than seven days, and higher morphine milligram equivalents per day.
In conclusion, prolonged use is prevalent among patients prescribed opioids for acute musculoskeletal injuries. It is advisable to avoid prescribing opioids for acute musculoskeletal injuries among patients with a history of substance abuse disorder and restricting dosage duration to a week or less if possible. Using lower dosages when prescribed, are potentially essential targets to reduce continued opioid use rates.