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. 2020 Sep 1;21(9):1818-1824.
doi: 10.1093/pm/pnaa161.

Frequency of Early Refills for Opioids in the United States

David M Kern  1 , M Soledad Cepeda  1 , Maribel Salas  2   3 , Syd Phillips  4 , Matthew H Secrest  5 , Gregory P Wedin  6
Affiliations

Frequency of Early Refills for Opioids in the United States

David M Kern et al. Pain Med. .

Abstract

Objective: Refilling an opioid prescription early is an important risk factor of prescription opioid abuse and misuse; we aimed to understand the scope of this behavior. This study was conducted to quantify the prevalence and distribution of early refills among patients prescribed opioids.

Methods: We conducted a retrospective cohort study utilizing dispensed prescription records. Patients filling one or more prescription opioids were identified and followed for one year. Early refills were defined as having a second prescription filled ≥15% early relative to the days' supply of the previous prescription for the same opioid (according to the National Drug Code [NDC]). The distribution of the number of early refills and patient characteristics were assessed.

Results: A total of 60.6 million patients met the study criteria; 28.8% had two or more opioid prescriptions for the same opioid during follow-up. Less than 3% of all patients receiving an opioid had an early refill. Approximately 10% of those with two or more opioid prescriptions for the same drug had an early refill. For patients with multiple fills (N = 1.5 million with extended-release long-acting [ER/LA] opioids; N = 17.1 million with immediate-release short-acting [IR/SA] opioids), early refills were more common among patients with an ER/LA opioid (18.5%) compared with an IR/SA opioid (8.7%). Three-quarters of patients with an early refill had only one (70.9% and 78.4% for ER/LA and IR/SA, respectively).

Conclusion: Refilling an opioid prescription with the same opioid early is an infrequent behavior within all opioid users, but more common in ER/LA users. Patients who refilled early tended to do so just once.

Keywords: Continuing; Early Refills; Education; Opioid Abuse; Opioids; REMS; Substance Abuse.

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Figures

Figure 1
Figure 1
Example of the early refill period for a 30-day prescription of an opioid. The early refill window starts on the fill date and extends to 85% of the days’ supply (30 * 0.85 = 25.5 days). A second prescription filled during this window would be considered an early refill.
See this image and copyright information in PMC

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