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First Opioid Prescription and Subsequent High-Risk Opioid Use: a National Study of Privately Insured and Medicare Advantage Adults.
J Gen Intern Med. 2018 12; 33(12):2156-2162.JG

Abstract

BACKGROUND

National guidelines make recommendations regarding the initial opioid prescriptions, but most of the supporting evidence is from the initial episode of care, not the first prescription.

OBJECTIVE

To examine associations between features of the first opioid prescription and high-risk opioid use in the 18 months following the first prescription.

DESIGN

Retrospective cohort study using data from a large commercial insurance claims database for 2011-2014 to identify individuals with no recent use of opioids and follow them for 18 months after the first opioid prescription.

PARTICIPANTS

Privately insured patients aged 18-64 and Medicare Advantage patients aged 65 or older who filled a first opioid prescription between 07/01/2011 and 06/30/2013.

MAIN OUTCOMES AND MEASURES

High-risk opioid use was measured by having (1) opioid prescriptions overlapping for 7 days or more, (2) opioid and benzodiazepine prescriptions overlapping for 7 days or more, (3) three or more prescribers of opioids, and (4) a daily dosage exceeding 120 morphine milligram equivalents, in each of the six quarters following the first prescription.

KEY RESULTS

All three features of the first prescription were strongly associated with high-risk use. For example, among privately insured patients, receiving a long- (vs. short-) acting first opioid was associated with a 16.9-percentage-point increase (95% CI, 14.3-19.5), a daily MME of 50 or more (vs. less than 30) was associated with a 12.5-percentage-point increase (95% CI, 12.1-12.9), and a supply exceeding 7 days (vs. 3 or fewer days) was associated with a 4.8-percentage-point increase (95% CI, 4.5-5.2), in the probability of having a daily dosage of 120 MMEs or more in the long term, compared to a sample mean of 4.2%. Results for the Medicare Advantage patients were similar.

CONCLUSIONS

Long-acting formulation, high daily dosage, and longer duration of the first opioid prescription were each associated with increased high-risk use of opioids in the long term.

Authors+Show Affiliations

Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA.Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA.Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA.Department of Medicine, Weill Cornell Medical College, New York, NY, USA.Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA. Division of Pain Medicine, New York-Presbyterian/Lower Manhattan Hospital, New York, NY, USA.Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA. Department of Medicine, Weill Cornell Medical College, New York, NY, USA. Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA.Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA.Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA. yub2003@med.cornell.edu. Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA. yub2003@med.cornell.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

30206790

Citation

Zhang, Yongkang, et al. "First Opioid Prescription and Subsequent High-Risk Opioid Use: a National Study of Privately Insured and Medicare Advantage Adults." Journal of General Internal Medicine, vol. 33, no. 12, 2018, pp. 2156-2162.
Zhang Y, Johnson P, Jeng PJ, et al. First Opioid Prescription and Subsequent High-Risk Opioid Use: a National Study of Privately Insured and Medicare Advantage Adults. J Gen Intern Med. 2018;33(12):2156-2162.
Zhang, Y., Johnson, P., Jeng, P. J., Reid, M. C., Witkin, L. R., Schackman, B. R., Ancker, J. S., & Bao, Y. (2018). First Opioid Prescription and Subsequent High-Risk Opioid Use: a National Study of Privately Insured and Medicare Advantage Adults. Journal of General Internal Medicine, 33(12), 2156-2162. https://doi.org/10.1007/s11606-018-4628-y
Zhang Y, et al. First Opioid Prescription and Subsequent High-Risk Opioid Use: a National Study of Privately Insured and Medicare Advantage Adults. J Gen Intern Med. 2018;33(12):2156-2162. PubMed PMID: 30206790.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - First Opioid Prescription and Subsequent High-Risk Opioid Use: a National Study of Privately Insured and Medicare Advantage Adults. AU - Zhang,Yongkang, AU - Johnson,Phyllis, AU - Jeng,Philip J, AU - Reid,M Carrington, AU - Witkin,Lisa R, AU - Schackman,Bruce R, AU - Ancker,Jessica S, AU - Bao,Yuhua, Y1 - 2018/09/11/ PY - 2018/02/05/received PY - 2018/07/27/accepted PY - 2018/05/24/revised PY - 2018/9/13/pubmed PY - 2019/11/19/medline PY - 2018/9/13/entrez KW - health services research KW - pain KW - physician behavior KW - prescription drug abuse SP - 2156 EP - 2162 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 33 IS - 12 N2 - BACKGROUND: National guidelines make recommendations regarding the initial opioid prescriptions, but most of the supporting evidence is from the initial episode of care, not the first prescription. OBJECTIVE: To examine associations between features of the first opioid prescription and high-risk opioid use in the 18 months following the first prescription. DESIGN: Retrospective cohort study using data from a large commercial insurance claims database for 2011-2014 to identify individuals with no recent use of opioids and follow them for 18 months after the first opioid prescription. PARTICIPANTS: Privately insured patients aged 18-64 and Medicare Advantage patients aged 65 or older who filled a first opioid prescription between 07/01/2011 and 06/30/2013. MAIN OUTCOMES AND MEASURES: High-risk opioid use was measured by having (1) opioid prescriptions overlapping for 7 days or more, (2) opioid and benzodiazepine prescriptions overlapping for 7 days or more, (3) three or more prescribers of opioids, and (4) a daily dosage exceeding 120 morphine milligram equivalents, in each of the six quarters following the first prescription. KEY RESULTS: All three features of the first prescription were strongly associated with high-risk use. For example, among privately insured patients, receiving a long- (vs. short-) acting first opioid was associated with a 16.9-percentage-point increase (95% CI, 14.3-19.5), a daily MME of 50 or more (vs. less than 30) was associated with a 12.5-percentage-point increase (95% CI, 12.1-12.9), and a supply exceeding 7 days (vs. 3 or fewer days) was associated with a 4.8-percentage-point increase (95% CI, 4.5-5.2), in the probability of having a daily dosage of 120 MMEs or more in the long term, compared to a sample mean of 4.2%. Results for the Medicare Advantage patients were similar. CONCLUSIONS: Long-acting formulation, high daily dosage, and longer duration of the first opioid prescription were each associated with increased high-risk use of opioids in the long term. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/30206790/First_Opioid_Prescription_and_Subsequent_High_Risk_Opioid_Use:_a_National_Study_of_Privately_Insured_and_Medicare_Advantage_Adults_ L2 - https://dx.doi.org/10.1007/s11606-018-4628-y DB - PRIME DP - Unbound Medicine ER -