Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients: A Statewide Retrospective Cohort Study

Richard (Rick) Deyo, Sara E. Hallvik, Christi Hildebran, Miguel Marino, Eve Dexter, Jessica M. Irvine, Nicole O’Kane, Joshua van Otterloo, Dagan A. Wright, Gillian Leichtling, Lisa M. Millet

Research output: Contribution to journalArticle

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Abstract

Background: Long-term efficacy of opioids for non-cancer pain is unproven, but risks argue for cautious prescribing. Few data suggest how long or how much opioid can be prescribed for opioid-naïve patients without inadvertently promoting long-term use. Objective: To examine the association between initial opioid prescribing patterns and likelihood of long-term use among opioid-naïve patients. Design: Retrospective cohort study; data from Oregon resident prescriptions linked to death certificates and hospital discharges. Participants: Patients filling opioid prescriptions between October 1, 2012, and September 30, 2013, with no opioid fills for the previous 365 days. Subgroup analyses examined patients under age 45 who did not die in the follow-up year, excluding most cancer or palliative care patients. Main Measures: Exposure: Numbers of prescription fills and cumulative morphine milligram equivalents (MMEs) dispensed during 30 days following opioid initiation (“initiation month”). Outcome: Proportion of patients with six or more opioid fills during the subsequent year (“long-term users”). Key Results: There were 536,767 opioid-naïve patients who filled an opioid prescription. Of these, 26,785 (5.0 %) became long-term users. Numbers of fills and cumulative MMEs during the initiation month were associated with long-term use. Among patients under age 45 using short-acting opioids who did not die in the follow-up year, the adjusted odds ratio (OR) for long-term use among those receiving two fills versus one was 2.25 (95 % CI: 2.17, 2.33). Compared to those who received < 120 total MMEs, those who received between 400 and 799 had an OR of 2.96 (95 % CI: 2.81, 3.11). Patients initiating with long-acting opioids had a higher risk of long-term use than those initiating with short-acting drugs. Conclusions: Early opioid prescribing patterns are associated with long-term use. While patient characteristics are important, clinicians have greater control over initial prescribing. Our findings may help minimize the risk of inadvertently initiating long-term opioid use.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalJournal of General Internal Medicine
DOIs
StateAccepted/In press - Aug 2 2016

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Opioid Analgesics
Cohort Studies
Retrospective Studies
Prescriptions
Morphine
Odds Ratio
Inappropriate Prescribing
Death Certificates
Palliative Care

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients : A Statewide Retrospective Cohort Study. / Deyo, Richard (Rick); Hallvik, Sara E.; Hildebran, Christi; Marino, Miguel; Dexter, Eve; Irvine, Jessica M.; O’Kane, Nicole; van Otterloo, Joshua; Wright, Dagan A.; Leichtling, Gillian; Millet, Lisa M.

In: Journal of General Internal Medicine, 02.08.2016, p. 1-7.

Research output: Contribution to journalArticle

Deyo, Richard (Rick) ; Hallvik, Sara E. ; Hildebran, Christi ; Marino, Miguel ; Dexter, Eve ; Irvine, Jessica M. ; O’Kane, Nicole ; van Otterloo, Joshua ; Wright, Dagan A. ; Leichtling, Gillian ; Millet, Lisa M. / Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients : A Statewide Retrospective Cohort Study. In: Journal of General Internal Medicine. 2016 ; pp. 1-7.
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abstract = "Background: Long-term efficacy of opioids for non-cancer pain is unproven, but risks argue for cautious prescribing. Few data suggest how long or how much opioid can be prescribed for opioid-na{\"i}ve patients without inadvertently promoting long-term use. Objective: To examine the association between initial opioid prescribing patterns and likelihood of long-term use among opioid-na{\"i}ve patients. Design: Retrospective cohort study; data from Oregon resident prescriptions linked to death certificates and hospital discharges. Participants: Patients filling opioid prescriptions between October 1, 2012, and September 30, 2013, with no opioid fills for the previous 365 days. Subgroup analyses examined patients under age 45 who did not die in the follow-up year, excluding most cancer or palliative care patients. Main Measures: Exposure: Numbers of prescription fills and cumulative morphine milligram equivalents (MMEs) dispensed during 30 days following opioid initiation (“initiation month”). Outcome: Proportion of patients with six or more opioid fills during the subsequent year (“long-term users”). Key Results: There were 536,767 opioid-na{\"i}ve patients who filled an opioid prescription. Of these, 26,785 (5.0 {\%}) became long-term users. Numbers of fills and cumulative MMEs during the initiation month were associated with long-term use. Among patients under age 45 using short-acting opioids who did not die in the follow-up year, the adjusted odds ratio (OR) for long-term use among those receiving two fills versus one was 2.25 (95 {\%} CI: 2.17, 2.33). Compared to those who received < 120 total MMEs, those who received between 400 and 799 had an OR of 2.96 (95 {\%} CI: 2.81, 3.11). Patients initiating with long-acting opioids had a higher risk of long-term use than those initiating with short-acting drugs. Conclusions: Early opioid prescribing patterns are associated with long-term use. While patient characteristics are important, clinicians have greater control over initial prescribing. Our findings may help minimize the risk of inadvertently initiating long-term opioid use.",
author = "Deyo, {Richard (Rick)} and Hallvik, {Sara E.} and Christi Hildebran and Miguel Marino and Eve Dexter and Irvine, {Jessica M.} and Nicole O’Kane and {van Otterloo}, Joshua and Wright, {Dagan A.} and Gillian Leichtling and Millet, {Lisa M.}",
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T1 - Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients

T2 - A Statewide Retrospective Cohort Study

AU - Deyo, Richard (Rick)

AU - Hallvik, Sara E.

AU - Hildebran, Christi

AU - Marino, Miguel

AU - Dexter, Eve

AU - Irvine, Jessica M.

AU - O’Kane, Nicole

AU - van Otterloo, Joshua

AU - Wright, Dagan A.

AU - Leichtling, Gillian

AU - Millet, Lisa M.

PY - 2016/8/2

Y1 - 2016/8/2

N2 - Background: Long-term efficacy of opioids for non-cancer pain is unproven, but risks argue for cautious prescribing. Few data suggest how long or how much opioid can be prescribed for opioid-naïve patients without inadvertently promoting long-term use. Objective: To examine the association between initial opioid prescribing patterns and likelihood of long-term use among opioid-naïve patients. Design: Retrospective cohort study; data from Oregon resident prescriptions linked to death certificates and hospital discharges. Participants: Patients filling opioid prescriptions between October 1, 2012, and September 30, 2013, with no opioid fills for the previous 365 days. Subgroup analyses examined patients under age 45 who did not die in the follow-up year, excluding most cancer or palliative care patients. Main Measures: Exposure: Numbers of prescription fills and cumulative morphine milligram equivalents (MMEs) dispensed during 30 days following opioid initiation (“initiation month”). Outcome: Proportion of patients with six or more opioid fills during the subsequent year (“long-term users”). Key Results: There were 536,767 opioid-naïve patients who filled an opioid prescription. Of these, 26,785 (5.0 %) became long-term users. Numbers of fills and cumulative MMEs during the initiation month were associated with long-term use. Among patients under age 45 using short-acting opioids who did not die in the follow-up year, the adjusted odds ratio (OR) for long-term use among those receiving two fills versus one was 2.25 (95 % CI: 2.17, 2.33). Compared to those who received < 120 total MMEs, those who received between 400 and 799 had an OR of 2.96 (95 % CI: 2.81, 3.11). Patients initiating with long-acting opioids had a higher risk of long-term use than those initiating with short-acting drugs. Conclusions: Early opioid prescribing patterns are associated with long-term use. While patient characteristics are important, clinicians have greater control over initial prescribing. Our findings may help minimize the risk of inadvertently initiating long-term opioid use.

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