Opioid addiction and fatal overdoses are rising across the country in what many have called a “national epidemic.” Patients who are prescribed opioids by a doctor, especially those with a history of substance abuse, are at a higher risk of using the drugs long-term, a new study finds.

Researchers at the Mayo Clinic studied a random sample of 293 patients who in 2009 received a new short-term prescription for an opioid painkiller, such as oxycodone, morphine, codeine, methadone, or others. They found that 21% of patients, or one in four, progressed from a short-term to a long-term prescription lasting three to four months, and 6% were prescribed the drug beyond four months.

They also found that patients with a history of smoking, or heavy drug or alcohol use, were more likely to receive long-term prescriptions. Doctors should be wary about prescribing painkillers to patients with such histories, said Hooten, because opioids activate the brain in a similar way to nicotine, alcohol, or other addictive drugs. But he said all patients should “proceed with caution” when receiving painkiller prescriptions regardless of their history.

He also advises holistic alternatives as a less risky approach to pain treatment. “I encourage use of alternative methods to manage pain, including non-opioid analgesics or other non-medication approaches,” he said. “That reduces, or even eliminates, the risk of these medications transitioning to another problem that was never intended.”

Using opioids over a long period of time can actually increase one’s pain sensitivity, said Hooten. So in cases where it must be used, like after surgery or a traumatic injury, reducing dosage and limiting duration of use is important.

“The next step in this research is to drill down and find more detailed information about the potential role of dose and quantity of medication prescribed,” he said. “It is possible that higher dose or greater quantities of the drug with each prescription are important predictors of longer-term use.”