Abstract
Study objective: The link between prescription opioid shopping and overdose events is poorly understood. We test the hypothesis that a history of prescription opioid shopping is associated with increased risk of overdose events. Methods: This is a secondary analysis of a linked claims and controlled substance dispense database. We studied adult Medicaid beneficiaries in 2014 with prescription opioid use in the 6 months before an ambulatory care or emergency department visit with a pain-related diagnosis. The primary outcome was a nonfatal overdose event within 6 months of the cohort entry date. The exposure of interest (opioid shopping) was defined as having opioid prescriptions by different prescribers with greater than or equal to 1-day overlap and filled at 3 or more pharmacies in the 6 months before cohort entry. We used a propensity score to match shoppers with nonshoppers in a 1:1 ratio. We calculated the absolute difference in outcome rates between shoppers and nonshoppers. Results: We studied 66,328 patients, including 2,571 opioid shoppers (3.9%). There were 290 patients (0.4%) in the overall cohort who experienced a nonfatal overdose. In unadjusted analyses, shoppers had higher event rates than nonshoppers (rate difference of 4.4 events per 1,000; 95% confidence interval 0.8 to 7.9). After propensity score matching, there were no outcome differences between shoppers and nonshoppers (rate difference of 0.4 events per 1,000; 95% confidence interval -4.7 to 5.5). These findings were robust to various definitions of opioid shoppers and look-back periods. Conclusion: Prescription opioid shopping is not independently associated with increased risk of overdose events.
| Original language | English (US) |
|---|---|
| Journal | Annals of Emergency Medicine |
| DOIs | |
| State | Accepted/In press - Jan 1 2017 |
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ASJC Scopus subject areas
- Emergency Medicine
Cite this
Does Prescription Opioid Shopping Increase Overdose Rates in Medicaid Beneficiaries? / Sun, Benjamin; Lupulescu-Mann, Nicoleta; Charlesworth, Christina J.; Kim, Hyunjee; Hartung, Daniel M.; Deyo, Richard (Rick); McConnell, Kenneth (John).
In: Annals of Emergency Medicine, 01.01.2017.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Does Prescription Opioid Shopping Increase Overdose Rates in Medicaid Beneficiaries?
AU - Sun, Benjamin
AU - Lupulescu-Mann, Nicoleta
AU - Charlesworth, Christina J.
AU - Kim, Hyunjee
AU - Hartung, Daniel M.
AU - Deyo, Richard (Rick)
AU - McConnell, Kenneth (John)
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Study objective: The link between prescription opioid shopping and overdose events is poorly understood. We test the hypothesis that a history of prescription opioid shopping is associated with increased risk of overdose events. Methods: This is a secondary analysis of a linked claims and controlled substance dispense database. We studied adult Medicaid beneficiaries in 2014 with prescription opioid use in the 6 months before an ambulatory care or emergency department visit with a pain-related diagnosis. The primary outcome was a nonfatal overdose event within 6 months of the cohort entry date. The exposure of interest (opioid shopping) was defined as having opioid prescriptions by different prescribers with greater than or equal to 1-day overlap and filled at 3 or more pharmacies in the 6 months before cohort entry. We used a propensity score to match shoppers with nonshoppers in a 1:1 ratio. We calculated the absolute difference in outcome rates between shoppers and nonshoppers. Results: We studied 66,328 patients, including 2,571 opioid shoppers (3.9%). There were 290 patients (0.4%) in the overall cohort who experienced a nonfatal overdose. In unadjusted analyses, shoppers had higher event rates than nonshoppers (rate difference of 4.4 events per 1,000; 95% confidence interval 0.8 to 7.9). After propensity score matching, there were no outcome differences between shoppers and nonshoppers (rate difference of 0.4 events per 1,000; 95% confidence interval -4.7 to 5.5). These findings were robust to various definitions of opioid shoppers and look-back periods. Conclusion: Prescription opioid shopping is not independently associated with increased risk of overdose events.
AB - Study objective: The link between prescription opioid shopping and overdose events is poorly understood. We test the hypothesis that a history of prescription opioid shopping is associated with increased risk of overdose events. Methods: This is a secondary analysis of a linked claims and controlled substance dispense database. We studied adult Medicaid beneficiaries in 2014 with prescription opioid use in the 6 months before an ambulatory care or emergency department visit with a pain-related diagnosis. The primary outcome was a nonfatal overdose event within 6 months of the cohort entry date. The exposure of interest (opioid shopping) was defined as having opioid prescriptions by different prescribers with greater than or equal to 1-day overlap and filled at 3 or more pharmacies in the 6 months before cohort entry. We used a propensity score to match shoppers with nonshoppers in a 1:1 ratio. We calculated the absolute difference in outcome rates between shoppers and nonshoppers. Results: We studied 66,328 patients, including 2,571 opioid shoppers (3.9%). There were 290 patients (0.4%) in the overall cohort who experienced a nonfatal overdose. In unadjusted analyses, shoppers had higher event rates than nonshoppers (rate difference of 4.4 events per 1,000; 95% confidence interval 0.8 to 7.9). After propensity score matching, there were no outcome differences between shoppers and nonshoppers (rate difference of 0.4 events per 1,000; 95% confidence interval -4.7 to 5.5). These findings were robust to various definitions of opioid shoppers and look-back periods. Conclusion: Prescription opioid shopping is not independently associated with increased risk of overdose events.
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UR - http://www.scopus.com/inward/citedby.url?scp=85035105985&partnerID=8YFLogxK
U2 - 10.1016/j.annemergmed.2017.10.007
DO - 10.1016/j.annemergmed.2017.10.007
M3 - Article
C2 - 29174833
AN - SCOPUS:85035105985
JO - Annals of Emergency Medicine
JF - Annals of Emergency Medicine
SN - 0196-0644
ER -