Title: Recommendations

Context:
Moderate quality evidence demonstrates that the prevalence of OUD in patients with CNCP is related to duration of opioid use as well as dose (see Recommendations 7-9).[86-88] There are two studies of  patients with CNCP which support the current recommendations. Edlund et al. (2014) conducted a large  retrospective cohort study where they examined claims data from a health insurance database between  2000 and 2005 to examine factors predictive of developing OUD.[86] Days’ supply of opioids was  categorized as none, acute duration (1-90 days), or chronic duration (91+ days). Average daily dose was  defined as none, low (1-36 mg MEDD), medium (36-120 mg MEDD), or high (>120 mg MEDD). The OR of  developing OUD ranged based on dose and duration (OR: 3.03, 95% CI: 2.32-3.95 for low dose, acute  opioid prescription; OR: 14.92, 95% CI: 10.38-21.46 for low dose, chronic opioids prescriptions; OR: 3.10,  95% CI: 1.67-5.77 for high dose, acute opioid prescriptions; OR: 122.45, 95% CI: 72.79-205.99 for high  dose, chronic opioid prescriptions). They found that even greater than opioid dose, duration of OT was the  strongest predictor of developing OUD. Additionally, a study by Boscarino et al. (2011) examined medical  records from a large healthcare system.[89] Through interviews with a random sample of patients on LOT,  they examined factors associated with and the prevalence of OUD (using DSM IV and 5 criteria). These  results showed that the prevalence of lifetime OUD for patients on LOT was 34.9% (based on DSM-5  criteria) and 35.5% (based on DSM-IV criteria).

Question: Which one is the strongest predictor of developing OUD among opioid dose and duration of OT?

Answer: duration of OT