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Guidelines suggest reducing or stopping opioids prescribed for chronic pain if the harms outweigh the benefits. Although the opioid epidemic has spurred providers to reduce opioid prescribing over the last decade, heroin and fentanyl deaths have increased. To learn how these trends interact, investigators performed a nested case-control study based on reviews of medical records of 22,962 patients who had received long-term prescriptions of opioids for pain.
Of 75 cases with documented heroin use after beginning opioid therapy, 60 had no previously documented use of heroin, and 1 had heroin use that led the physician to stop the opioid. The case patients were matched to 1045 non–heroin-using control patients. Time from opioid discontinuation …