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Using trajectory models to assess the effect of hydrocodone upscheduling among chronic hydrocodone users.
Pharmacoepidemiol Drug Saf. 2019 01; 28(1):70-79.PD

Abstract

PURPOSE

In October 2014, the US Drug Enforcement Agency moved hydrocodone combination products (HCPs) from schedule III to II of the Controlled Substances Act, further restricting their access. The aim of the study is to quantify the effect of hydrocodone's "upscheduling" on the use of opioid and nonopioid analgesics among chronic users.

METHODS

Using IQVIA LRx LifeLink anonymized pharmacy data 2013 to 2015, we performed interrupted time series analysis and group-based trajectory modeling to characterize the effect of rescheduling on 316 731 long-term hydrocodone users. Main measures were the number of prescriptions, patients, tablets, and morphine milligram equivalents of opioids and nonopioid analgesics pre and post the policy change. We used logistic regression to assess the relationship between sociodemographic characteristics and these measures.

RESULTS

The schedule change was associated with significant declines in opioid prescriptions (20.9%, from 421 798 to 333 627) and the number of patients using opioids (11.4%, from 307 974 to 272 804). Majority of hydrocodone users filled prescriptions for nonopioid analgesics with some declines in the number of users after the schedule change (5.2%, from 181 085 to 171 758). Based on group-based trajectory models, majority of patients continued to fill HCP prescriptions consistently after the policy change, while 15.4% showed large declines in HCP use, accounting for two-thirds of the decrease in opioid volume. There was no evidence that the policy change was associated with significant increases in the use of alternative analgesics.

CONCLUSIONS

The upscheduling of hydrocodone led to reductions in opioid use, which were concentrated among a small subset of chronic hydrocodone users, without evidence of commensurate increases in the use of alternative pharmacologic pain treatments.

Authors+Show Affiliations

Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA. Department of Anesthesiology and Critical Care, Johns Hopkins Medicine, Baltimore, MD, USA.Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services, Rockville, MD, USA.Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30187574

Citation

Murimi, Irene B., et al. "Using Trajectory Models to Assess the Effect of Hydrocodone Upscheduling Among Chronic Hydrocodone Users." Pharmacoepidemiology and Drug Safety, vol. 28, no. 1, 2019, pp. 70-79.
Murimi IB, Chang HY, Bicket M, et al. Using trajectory models to assess the effect of hydrocodone upscheduling among chronic hydrocodone users. Pharmacoepidemiol Drug Saf. 2019;28(1):70-79.
Murimi, I. B., Chang, H. Y., Bicket, M., Jones, C. M., & Alexander, G. C. (2019). Using trajectory models to assess the effect of hydrocodone upscheduling among chronic hydrocodone users. Pharmacoepidemiology and Drug Safety, 28(1), 70-79. https://doi.org/10.1002/pds.4639
Murimi IB, et al. Using Trajectory Models to Assess the Effect of Hydrocodone Upscheduling Among Chronic Hydrocodone Users. Pharmacoepidemiol Drug Saf. 2019;28(1):70-79. PubMed PMID: 30187574.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Using trajectory models to assess the effect of hydrocodone upscheduling among chronic hydrocodone users. AU - Murimi,Irene B, AU - Chang,Hsien-Yen, AU - Bicket,Mark, AU - Jones,Christopher M, AU - Alexander,G Caleb, Y1 - 2018/09/05/ PY - 2018/03/14/received PY - 2018/07/09/revised PY - 2018/07/17/accepted PY - 2018/9/7/pubmed PY - 2020/2/25/medline PY - 2018/9/7/entrez KW - NSAIDS KW - gabapentin KW - group-based trajectory models KW - hydrodocone combination products KW - nonopioid analgesics KW - opioids KW - pharmacoepidemiology KW - pregabalin SP - 70 EP - 79 JF - Pharmacoepidemiology and drug safety JO - Pharmacoepidemiol Drug Saf VL - 28 IS - 1 N2 - PURPOSE: In October 2014, the US Drug Enforcement Agency moved hydrocodone combination products (HCPs) from schedule III to II of the Controlled Substances Act, further restricting their access. The aim of the study is to quantify the effect of hydrocodone's "upscheduling" on the use of opioid and nonopioid analgesics among chronic users. METHODS: Using IQVIA LRx LifeLink anonymized pharmacy data 2013 to 2015, we performed interrupted time series analysis and group-based trajectory modeling to characterize the effect of rescheduling on 316 731 long-term hydrocodone users. Main measures were the number of prescriptions, patients, tablets, and morphine milligram equivalents of opioids and nonopioid analgesics pre and post the policy change. We used logistic regression to assess the relationship between sociodemographic characteristics and these measures. RESULTS: The schedule change was associated with significant declines in opioid prescriptions (20.9%, from 421 798 to 333 627) and the number of patients using opioids (11.4%, from 307 974 to 272 804). Majority of hydrocodone users filled prescriptions for nonopioid analgesics with some declines in the number of users after the schedule change (5.2%, from 181 085 to 171 758). Based on group-based trajectory models, majority of patients continued to fill HCP prescriptions consistently after the policy change, while 15.4% showed large declines in HCP use, accounting for two-thirds of the decrease in opioid volume. There was no evidence that the policy change was associated with significant increases in the use of alternative analgesics. CONCLUSIONS: The upscheduling of hydrocodone led to reductions in opioid use, which were concentrated among a small subset of chronic hydrocodone users, without evidence of commensurate increases in the use of alternative pharmacologic pain treatments. SN - 1099-1557 UR - https://www.unboundmedicine.com/medline/citation/30187574/Using_trajectory_models_to_assess_the_effect_of_hydrocodone_upscheduling_among_chronic_hydrocodone_users_ L2 - https://doi.org/10.1002/pds.4639 DB - PRIME DP - Unbound Medicine ER -