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Rethinking “long term” opioid therapy

BMJ 2019; 367 doi: (Published 29 November 2019) Cite this as: BMJ 2019;367:l6691
  1. Christina Abdel Shaheed, academic fellow12,
  2. Andrew J McLachlan, professor3,
  3. Chris G Maher, professor12
  1. 1Institute for Musculoskeletal Health, University of Sydney, Sydney, Australia
  2. 2School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
  3. 3School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
  1. Correspondence to: C Abdel Shaheed Christina.abdelshaheed{at}

Definitions are heterogeneous, arbitrary, and potentially harmful

Long term opioid therapy for non-cancer pain has been much debated because of concerns that the harms may outweigh benefits. What has received less attention is how long term should be defined and whether the label has any value for patients, doctors, or researchers.

Although long term opioid therapy seems a simple concept, definitions vary widely. Most studies define long term as ≥90 days of opioid use, but the threshold ranges from one week to one year.12 Definitions also vary in terms of frequency of use (consistent daily dosing versus intermittent use) and if use is self-reported or based on dispensing records. Other definitions consider the dose as well as duration. Variations in terminology (such as chronic opioid therapy) add further confusion.

The variation in definitions has important consequences. Although the scientific community agrees there is an opioid crisis, without a consistent definition we cannot characterise the crisis or measure the success of interventions to tackle it. It is impossible to get consistent and reproducible …

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