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, K. John
N1 - Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This study was supported by National Institutes of Health (NIH) grant R01DA036522.
Publisher Copyright:
© 2017 American College of Emergency Physicians
PY - 2018/6
Y1 - 2018/6
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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U2 - 10.1016/j.annemergmed.2017.10.007
DO - 10.1016/j.annemergmed.2017.10.007
M3 - Article
C2 - 29174833
AN - SCOPUS:85035105985
VL - 71
SP - 679-687.e3
JO - Journal of the American College of Emergency Physicians
JF - Journal of the American College of Emergency Physicians
SN - 0196-0644
IS - 6
ER -