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Trends in Opioid Prescribing Among Hemodialysis Patients, 2007-2014.
Am J Nephrol. 2019; 49(1):20-31.AJ

Abstract

BACKGROUND

Hemodialysis (HD) patients frequently experience pain. Previous studies of HD patients suggest increased opioid prescribing through 2010. It remains unclear if this trend continued after 2010 or declined with national trends.

METHODS

Longitudinal cohort study of 484,745 HD patients in the United States Renal Data System/Medicare data. We used Poisson/negative binomial regression to estimate annual incidence rates of opioid prescribing between 2007 and 2014. We compared prescribing rates with the general US population using IQVIA's National Prescription Audit data. Outcomes included the following: percent of HD patients receiving an opioid prescription, rate of opioid prescriptions, quantity, days supply, morphine milligram equivalents (MME) dispensed per 100 person-days, and prescriptions per person.

RESULTS

In 2007, 62.4% of HD patients received an opioid prescription. This increased to 63.2% in 2010 then declined to 53.7% by 2014. Opioid quantity peaked in 2011 at 73.5 pills per 100 person-days and declined to 62.6 pills per 100 person-days in 2014. MME peaked between 2010 and 2012 then declined through 2014. In 2014, MME rates were 1.8-fold higher among non-Hispanic patients and 1.6-fold higher among low-income patients. HD patients received 3.2-fold more opioid prescriptions per person compared to the general US population and were primarily prescribed oxycodone and hydrocodone. Between 2012 and 2014, HD patients experienced greater declines in opioid prescriptions per person (18.2%) compared to the general US population (7.1%).

CONCLUSION

Opioid prescribing among HD patients declined between 2012 and 2014. However, HD patients continue receiving substantially more opioids than the general US population.

Authors+Show Affiliations

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, Maryland, USA.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, Maryland, USA. Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA.Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Division of Surgery, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, mara@jhu.edu. Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, Maryland, USA, mara@jhu.edu. Division of Surgery, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, mara@jhu.edu.

Pub Type(s)

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

Language

eng

PubMed ID

30544114

Citation

Daubresse, Matthew, et al. "Trends in Opioid Prescribing Among Hemodialysis Patients, 2007-2014." American Journal of Nephrology, vol. 49, no. 1, 2019, pp. 20-31.
Daubresse M, Alexander GC, Crews DC, et al. Trends in Opioid Prescribing Among Hemodialysis Patients, 2007-2014. Am J Nephrol. 2019;49(1):20-31.
Daubresse, M., Alexander, G. C., Crews, D. C., Segev, D. L., & McAdams-DeMarco, M. A. (2019). Trends in Opioid Prescribing Among Hemodialysis Patients, 2007-2014. American Journal of Nephrology, 49(1), 20-31. https://doi.org/10.1159/000495353
Daubresse M, et al. Trends in Opioid Prescribing Among Hemodialysis Patients, 2007-2014. Am J Nephrol. 2019;49(1):20-31. PubMed PMID: 30544114.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in Opioid Prescribing Among Hemodialysis Patients, 2007-2014. AU - Daubresse,Matthew, AU - Alexander,G Caleb, AU - Crews,Deidra C, AU - Segev,Dorry L, AU - McAdams-DeMarco,Mara A, Y1 - 2018/12/13/ PY - 2018/09/13/received PY - 2018/11/08/accepted PY - 2018/12/14/pubmed PY - 2020/3/31/medline PY - 2018/12/14/entrez KW - Hemodialysis KW - Opioid prescribing KW - Trends KW - United States SP - 20 EP - 31 JF - American journal of nephrology JO - Am J Nephrol VL - 49 IS - 1 N2 - BACKGROUND: Hemodialysis (HD) patients frequently experience pain. Previous studies of HD patients suggest increased opioid prescribing through 2010. It remains unclear if this trend continued after 2010 or declined with national trends. METHODS: Longitudinal cohort study of 484,745 HD patients in the United States Renal Data System/Medicare data. We used Poisson/negative binomial regression to estimate annual incidence rates of opioid prescribing between 2007 and 2014. We compared prescribing rates with the general US population using IQVIA's National Prescription Audit data. Outcomes included the following: percent of HD patients receiving an opioid prescription, rate of opioid prescriptions, quantity, days supply, morphine milligram equivalents (MME) dispensed per 100 person-days, and prescriptions per person. RESULTS: In 2007, 62.4% of HD patients received an opioid prescription. This increased to 63.2% in 2010 then declined to 53.7% by 2014. Opioid quantity peaked in 2011 at 73.5 pills per 100 person-days and declined to 62.6 pills per 100 person-days in 2014. MME peaked between 2010 and 2012 then declined through 2014. In 2014, MME rates were 1.8-fold higher among non-Hispanic patients and 1.6-fold higher among low-income patients. HD patients received 3.2-fold more opioid prescriptions per person compared to the general US population and were primarily prescribed oxycodone and hydrocodone. Between 2012 and 2014, HD patients experienced greater declines in opioid prescriptions per person (18.2%) compared to the general US population (7.1%). CONCLUSION: Opioid prescribing among HD patients declined between 2012 and 2014. However, HD patients continue receiving substantially more opioids than the general US population. SN - 1421-9670 UR - https://www.unboundmedicine.com/medline/citation/30544114/Trends_in_Opioid_Prescribing_Among_Hemodialysis_Patients_2007_2014_ L2 - https://www.karger.com?DOI=10.1159/000495353 DB - PRIME DP - Unbound Medicine ER -