Trends in prescription opioid use and dose trajectories before opioid use disorder or overdose in US adults from 2006 to 2016: A cross-sectional study

English version

Autoři: Yu-Jung Jenny Wei ^aff001; Cheng Chen ^aff001; Roger Fillingim ^aff003; Siegfried O. Schmidt ^aff005; Almut G. Winterstein ^aff001
Působiště autorů: Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America ^aff001; Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, United States of America ^aff002; College of Dentistry, University of Florida, Gainesville, Florida, United States of America ^aff003; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, United States of America ^aff004; Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America ^aff005; Department of Epidemiology, College of Medicine and College of Public Health & Health Professions, University of Florida, Gainesville, Florida, United States of America ^aff006
Vyšlo v časopise: Trends in prescription opioid use and dose trajectories before opioid use disorder or overdose in US adults from 2006 to 2016: A cross-sectional study. PLoS Med 16(11): e32767. doi:10.1371/journal.pmed.1002941
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1002941

Souhrn

Background

With governments’ increasing efforts to curb opioid prescription use and limit dose below the Centers for Disease Control and Prevention (CDC)-recommended threshold of 90 morphine milligram equivalents per day, little is known about prescription opioid patterns preceding opioid use disorder (OUD) or overdose. This study aimed to determine prescribed opioid fills and dose trajectories in the year before an incident OUD or overdose diagnosis using a 2005–2016 commercial healthcare database.

Methods and findings

This cross-sectional study identified individuals aged 18 to 64 years with incident OUD or overdose in the United States. We measured the prevalence of opioid prescription fills and trajectories of opioid morphine equivalent dose (MED) prescribed during the 12-month period before the diagnosis. Of 227,038 adults with incident OUD or overdose, 33.1% were aged 18 to 30 years, 52.9% were males, and 85.0% were metropolitan residents. Half (50.5%) of the patients had a diagnosis of chronic pain, 32.7% had depression, and 20.3% had anxiety. Overall, 79,747 (35.1%) patients filled no opioid prescription in the 12 months before OUD or overdose diagnosis, with the proportion significantly increasing between 2006 and 2016 (adjusted prevalence ratio, 1.86; 95% CI 1.79–1.93; P < 0.001). Patients without (versus with) prescribed opioids tended to be younger males and metropolitan and Northeast US residents. Of 145,609 patients who filled opioid prescriptions, 5 distinct prescribed daily dose trajectories preceding diagnosis emerged: consistent low dose (<3 mg MED, 34.6%), consistent moderate dose (20 mg MED, 27.3%), consistent high dose (150 mg MED, 15.0%), escalating dose (from <3 to 20 mg MED, 13.7%), and de-escalating dose (from 20 to <3mg MED, 9.4%). Overall, over two-thirds of patients with OUD or overdose with prescription opioids were prescribed a mean daily dose below 90 mg MED before diagnosis. Major limitations include the limited generalizability of the study findings and lack of information on out-of-pocket drug spending, race/ethnicity, and socioeconomic status of participants, which prevents analyses addressing these characteristics.

Conclusions

In this study, we found that absence of opioid prescription fills in the year before incident OUD or overdose diagnosis was prevalent, and the majority of the patients received prescription opioid doses below the risk threshold of 90 mg MED. An increasing proportion of high-risk patients could be missed by current programs solely based on opioid prescribing and dispensing information in this new era of limited access to prescription opioids.

Klíčová slova:

Age groups – Diagnostic medicine – Heroin – Insurance – Morphine – Myalgia – Neuropathic pain – Opioids

Zdroje

1. Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—united states, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016;64(50–51):1378–82. doi: 10.15585/mmwr.mm6450a3 26720857

2. Florence CS, Zhou C, Luo F, Xu L. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Med Care. 2016;54(10):901–6. doi: 10.1097/MLR.0000000000000625 27623005

3. Kirson NY, Shei A, Rice JB, Enloe CJ, Bodnar K, Birnbaum HG, et al. The Burden of Undiagnosed Opioid Abuse Among Commercially Insured Individuals. Pain Med. 2015;16(7):1325–32. doi: 10.1111/pme.12768 25929289

4. Jalal H, Buchanich JM, Roberts MS, Balmert LC, Zhang K, Burke DS. Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016. Sci. 2018;361(6408). pii: eaau1184. doi: 10.1126/science.aau1184 30237320

5. Bolash RB. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372(16):1573.

6. Guy GP Jr., Zhang K, Bohm MK, Losby J, Lewis B, Young R, et al. Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017;66(26):697–704. doi: 10.15585/mmwr.mm6626a4 28683056

7. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65(5051):1445–52.

8. O'Donnell JK, Gladden RM, Seth P. Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region—United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017;66(34):897–903. doi: 10.15585/mmwr.mm6634a2 28859052

9. Compton WM, Jones CM, Baldwin GT. Relationship between Nonmedical Prescription-Opioid Use and Heroin Use. N Engl J Med. 2016;374(2):154–63. doi: 10.1056/NEJMra1508490 26760086

10. Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. 2017;167(5):293–301. doi: 10.7326/M17-0865 28761945

11. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. MMWR Recomm Rep. 2016;65(1):1–49. doi: 10.15585/mmwr.rr6501e1 26987082

12. Dowell D, Zhang K, Noonan RK, Hockenberry JM. Mandatory Provider Review And Pain Clinic Laws Reduce The Amounts Of Opioids Prescribed And Overdose Death Rates. Health Aff (Millwood). 2016;35(10):1876–83.

13. Rubin R. CMS to Improve Drug Programs and Opioid Overuse Oversight. JAMA. 2018;319(12):1189.

14. Gabay M. Prescription Drug Monitoring Programs. Hosp Pharm. 2015;50(4):277–8. doi: 10.1310/hpj5004-277 26445918

15. Wei YJ, Chen C, Sarayani A, Winterstein AG. Performance of the Centers for Medicare & Medicaid Services' Opioid Overutilization Criteria for Classifying Opioid Use Disorder or Overdose. JAMA. 2019;321(6):609–11. doi: 10.1001/jama.2018.20404 30747958

16. Dart RC, Surratt HL, Cicero TJ, Parrino MW, Severtson SG, Bucher-Bartelson B, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372(3):241–8. doi: 10.1056/NEJMsa1406143 25587948

17. Nagin DS, Odgers CL. Group-based trajectory modeling in clinical research. Annu Rev Clin Psychol. 2010;6:109–38. doi: 10.1146/annurev.clinpsy.121208.131413 20192788

18. Green CA, Perrin NA, Janoff SL, Campbell CI, Chilcoat HD, Coplan PM. Assessing the accuracy of opioid overdose and poisoning codes in diagnostic information from electronic health records, claims data, and death records. Pharmacoepidemiol Drug Saf. 2017;26(5):509–17. doi: 10.1002/pds.4157 28074520

19. The Centers for Medicare and Medicaid Services. Opioid Oral Morphine Milligram Equivalent (MME) Conversion Factors. 2018 [cited 2018 Dec 1]. Available from: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Oral-MME-CFs-vFeb-2018.pdf

20. Edlund MJ, Steffick D, Hudson T, Harris KM, Sullivan M. Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain. 2007;129(3):355–62. doi: 10.1016/j.pain.2007.02.014 17449178

21. Edlund MJ, Martin BC, Fan MY, Devries A, Braden JB, Sullivan MD. Risks for opioid abuse and dependence among recipients of chronic opioid therapy: results from the TROUP study. Drug and Alcohol Depen. 2010;112(1–2):90–8.

22. Wilsey BL, Fishman SM, Tsodikov A, Ogden C, Symreng I, Ernst A. Psychological comorbidities predicting prescription opioid abuse among patients in chronic pain presenting to the emergency department. Pain Med. 2008;9(8):1107–17. doi: 10.1111/j.1526-4637.2007.00401.x 18266809

23. Cochran BN, Flentje A, Heck NC, Van Den Bos J, Perlman D, Torres J, et al. Factors predicting development of opioid use disorders among individuals who receive an initial opioid prescription: mathematical modeling using a database of commercially-insured individuals. Drug and Alcohol Depen. 2014;138:202–8.

24. Von Korff M, Walker RL, Saunders K, Shortreed SM, Thakral M, Parchman M, et al. Prevalence of prescription opioid use disorder among chronic opioid therapy patients after health plan opioid dose and risk reduction initiatives. Int J Drug Policy. 2017;46:90–8. doi: 10.1016/j.drugpo.2017.05.053 28666143

25. Heslin KC, Owens PL, Karaca Z, Barrett ML, Moore BJ, Elixhauser A. Trends in Opioid-related Inpatient Stays Shifted After the US Transitioned to ICD-10-CM Diagnosis Coding in 2015. Med Care. 2017;55(11):918–23. doi: 10.1097/MLR.0000000000000805 28930890

26. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6. doi: 10.1093/aje/kwh090 15033648

27. Andruff H, Carraro N, Thompson A, Gaudreau P, Louvet B. Latent Class Growth Modelling: A Tutorial. Tutor Quant Methods Psychol. 2009;5(1):11–24.

28. Bohnert ASB, Guy GP Jr., Losby JL. Opioid Prescribing in the United States Before and After the Centers for Disease Control and Prevention's 2016 Opioid Guideline. Ann Intern Med. 2018;169(6):367–75. doi: 10.7326/M18-1243 30167651

29. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths—United States, 2013–2017. MMWR Morb Mortal Wkly Rep. 2018;67(5152):1419–27. doi: 10.15585/mmwr.mm675152e1 30605448

30. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821–6. doi: 10.1001/jamapsychiatry.2014.366 24871348

31. Stumbo SP, Yarborough BJ, McCarty D, Weisner C, Green CA. Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement. J Subst Abuse Treat. 2017;73:47–54. doi: 10.1016/j.jsat.2016.11.003 28017184

32. Mistry CJ, Bawor M, Desai D, Marsh DC, Samaan Z. Genetics of Opioid Dependence: A Review of the Genetic Contribution to Opioid Dependence. Curr Psychiatry Rev. 2014;10(2):156–67. doi: 10.2174/1573400510666140320000928 25242908

33. Adewumi AD, Hollingworth SA, Maravilla JC, Connor JP, Alati R. Prescribed Dose of Opioids and Overdose: A Systematic Review and Meta-Analysis of Unintentional Prescription Opioid Overdose. CNS Drugs. 2018;32(2):101–16. doi: 10.1007/s40263-018-0499-3 29498021

34. Evoy KE, Morrison MD, Saklad SR. Abuse and Misuse of Pregabalin and Gabapentin. Drugs. 2017;77(4):403–26. doi: 10.1007/s40265-017-0700-x 28144823

35. Slavova S, Miller A, Bunn TL, White JR, Kirschke D, Light T, et al. Prevalence of gabapentin in drug overdose postmortem toxicology testing results. Drug and Alcohol Depen. 2018;186:80–5.

36. Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016;111(7):1160–74. doi: 10.1111/add.13324 27265421

37. US Food and Drug Administration. FDA requests removal of Opana ER for risks related to abuse. 2017 [cited 2018 Dec 1]. Available from: https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm562401.htm.

38. Jones CM, Logan J, Gladden RM, Bohm MK. Vital Signs: Demographic and Substance Use Trends Among Heroin Users—United States, 2002–2013. MMWR Morb Mortal Wkly Rep. 2015;64(26):719–25. 26158353

39. Fudin J, Raouf M, Wegrzyn EL, Schatman ME. Safety concerns with the Centers for Disease Control opioid calculator. J Pain Res. 2018;11:1–4. doi: 10.2147/JPR.S155444 29296093