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Patterns of Potential Opioid Misuse and Subsequent Adverse Outcomes in Medicare, 2008 to 2012.
Ann Intern Med. 2018 06 19; 168(12):837-845.AIM

Abstract

Background

Providers are increasingly being expected to examine their patients' opioid treatment histories before writing new opioid prescriptions. However, little evidence exists on how patterns of potential opioid misuse are associated with subsequent adverse outcomes nationally.

Objective

To estimate how a range of patterns of potential opioid misuse relate to adverse outcomes during the subsequent year.

Design

Observational study comparing outcomes for Medicare enrollees with potential opioid misuse patterns versus those for beneficiaries with no such patterns, adjusting for patient characteristics.

Setting

Medicare, 2008 to 2012.

Patients

A 5% sample of beneficiaries who had an opioid prescription without a cancer diagnosis.

Measurements

Several measures for opioid misuse were defined on the basis of drug quantity, overlapping prescriptions, use of multiple prescribers or pharmacies, and use of out-of-state prescribers or pharmacies. The primary outcome was a diagnosis of opioid overdose in the year after a 6-month index period. Secondary outcomes included subsequent opioid-related or overall mortality.

Results

Overall, 0.6% to 8.5% of beneficiaries fulfilled a misuse measure. Subsequent opioid overdose was positively associated with successively greater numbers of prescribers or pharmacies or higher opioid quantities during the index period. For example, patients who obtained opioids from 2, 3, or 4 prescribers were increasingly more likely to have an opioid overdose (adjusted absolute risk per 1000 beneficiary-years [aAR], 3.5 [95% CI, 3.3 to 3.7]; 4.8 [CI, 4.5 to 5.2]; or 6.4 [CI, 5.8 to 6.9], respectively) than those with a single prescriber (aAR, 1.9 [CI, 1.8 to 2.0]). Subsequent overdose risk increased meaningfully with any deviation in the single prescriber-single pharmacy opioid use pattern. All misuse measures examined had a positive association with subsequent opioid overdose and death.

Limitation

Risk estimates provide measures of association and may not generalize to non-Medicare populations.

Conclusion

To fully assess patients' opioid overdose risk, clinicians should examine a wide range of misuse patterns.

Primary Funding Source

National Institutes of Health.

Authors+Show Affiliations

Cornell University, Ithaca, New York (C.M.C.).Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, and National Bureau of Economic Research, Cambridge, Massachusetts (A.B.J.).Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts (M.L.B.).

Pub Type(s)

Journal Article
Observational Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29800019

Citation

Carey, Colleen M., et al. "Patterns of Potential Opioid Misuse and Subsequent Adverse Outcomes in Medicare, 2008 to 2012." Annals of Internal Medicine, vol. 168, no. 12, 2018, pp. 837-845.
Carey CM, Jena AB, Barnett ML. Patterns of Potential Opioid Misuse and Subsequent Adverse Outcomes in Medicare, 2008 to 2012. Ann Intern Med. 2018;168(12):837-845.
Carey, C. M., Jena, A. B., & Barnett, M. L. (2018). Patterns of Potential Opioid Misuse and Subsequent Adverse Outcomes in Medicare, 2008 to 2012. Annals of Internal Medicine, 168(12), 837-845. https://doi.org/10.7326/M17-3065
Carey CM, Jena AB, Barnett ML. Patterns of Potential Opioid Misuse and Subsequent Adverse Outcomes in Medicare, 2008 to 2012. Ann Intern Med. 2018 06 19;168(12):837-845. PubMed PMID: 29800019.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patterns of Potential Opioid Misuse and Subsequent Adverse Outcomes in Medicare, 2008 to 2012. AU - Carey,Colleen M, AU - Jena,Anupam B, AU - Barnett,Michael L, Y1 - 2018/05/22/ PY - 2018/5/26/pubmed PY - 2019/8/17/medline PY - 2018/5/26/entrez SP - 837 EP - 845 JF - Annals of internal medicine JO - Ann Intern Med VL - 168 IS - 12 N2 - Background: Providers are increasingly being expected to examine their patients' opioid treatment histories before writing new opioid prescriptions. However, little evidence exists on how patterns of potential opioid misuse are associated with subsequent adverse outcomes nationally. Objective: To estimate how a range of patterns of potential opioid misuse relate to adverse outcomes during the subsequent year. Design: Observational study comparing outcomes for Medicare enrollees with potential opioid misuse patterns versus those for beneficiaries with no such patterns, adjusting for patient characteristics. Setting: Medicare, 2008 to 2012. Patients: A 5% sample of beneficiaries who had an opioid prescription without a cancer diagnosis. Measurements: Several measures for opioid misuse were defined on the basis of drug quantity, overlapping prescriptions, use of multiple prescribers or pharmacies, and use of out-of-state prescribers or pharmacies. The primary outcome was a diagnosis of opioid overdose in the year after a 6-month index period. Secondary outcomes included subsequent opioid-related or overall mortality. Results: Overall, 0.6% to 8.5% of beneficiaries fulfilled a misuse measure. Subsequent opioid overdose was positively associated with successively greater numbers of prescribers or pharmacies or higher opioid quantities during the index period. For example, patients who obtained opioids from 2, 3, or 4 prescribers were increasingly more likely to have an opioid overdose (adjusted absolute risk per 1000 beneficiary-years [aAR], 3.5 [95% CI, 3.3 to 3.7]; 4.8 [CI, 4.5 to 5.2]; or 6.4 [CI, 5.8 to 6.9], respectively) than those with a single prescriber (aAR, 1.9 [CI, 1.8 to 2.0]). Subsequent overdose risk increased meaningfully with any deviation in the single prescriber-single pharmacy opioid use pattern. All misuse measures examined had a positive association with subsequent opioid overdose and death. Limitation: Risk estimates provide measures of association and may not generalize to non-Medicare populations. Conclusion: To fully assess patients' opioid overdose risk, clinicians should examine a wide range of misuse patterns. Primary Funding Source: National Institutes of Health. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/29800019/Patterns_of_Potential_Opioid_Misuse_and_Subsequent_Adverse_Outcomes_in_Medicare_2008_to_2012_ L2 - https://www.acpjournals.org/doi/10.7326/M17-3065?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -