Rates of adverse events of long-acting opioids in a state medicaid program

Daniel M. Hartung, Luke Middleton, Dean G. Haxby, Michele Koder, Kathy L. Ketchum, Roger Chou

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

BACKGROUND: Despite widespread use and emerging safety concerns, data on the comparative safety and effectiveness of long-acting opioid (LAO) analgesics are weak. OBJECTIVE: To compare rates of adverse events among patients newly prescribed an LAO. METHODS: A retrospective observational cohort study using Medicaid administrative claims data was conducted examining time until first adverse outcome among patients with new prescriptions for methadone, extended-release (ER) oxycodone, ER morphine, or transdermal fentanyl. Adverse outcomes included emergency department (ED) encounters or hospitalizations for opioid-related adverse events, all-cause ED encounters or hospitalizations, death, and diagnoses for opioid-related adverse effects. Cox proportional hazards models were used to adjust for a variety of measured covariates overall and within subgroups of patients with and without cancer. RESULTS: This study included 5684 subjects. Patients prescribed ER oxycodone were 35% less likely (adjusted hazard ratio [HR] 0.45; 95% CI 0.26 to 0.77) to experience an ED or hospitalization involving an opioid-related adverse event, 23% lower risk of hospitalization (adjusted HR 0.77; 95% CI 0.66 to 0.91), 41% lower risk of constipation (adjusted HR 0.59; 95% CI 0.35 to 1.00), and a 29% lower risk of death (adjusted HR 0.71; 95% CI 0.54 to 0.94) compared with those prescribed ER morphine. Among subjects with noncancer pain, fentanyl was associated with a higher risk of ED encounters (adjusted HR 1.27; 95% Cl 1.02 to 1.59) and methadone was associated with a greater risk of overdose symptoms (adjusted HR 1.57; 95% Cl 1.03 to 2.40) compared with ER morphine. CONCLUSIONS: Our results support a modest safety advantage with ER oxycodone compared with ER morphine. Among subjects with noncancer pain, fentanyl and methadone were associated with an increased risk of an adverse event compared with ER morphine. Additional studies are needed to confirm our findings and further clarify risks associated with different LAOs.

Original languageEnglish (US)
Pages (from-to)921-928
Number of pages8
JournalAnnals of Pharmacotherapy
Volume41
Issue number6
DOIs
StatePublished - Jun 2007

Fingerprint

Medicaid
Opioid Analgesics
Morphine
Oxycodone
Hospital Emergency Service
Methadone
Hospitalization
Fentanyl
Safety
Pain
Constipation
Proportional Hazards Models
Observational Studies
Prescriptions
Cohort Studies
Neoplasms

Keywords

  • Adverse effects
  • Opbid analgesics
  • Pharmacoepidemiology

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)
  • Medicine(all)

Cite this

Hartung, D. M., Middleton, L., Haxby, D. G., Koder, M., Ketchum, K. L., & Chou, R. (2007). Rates of adverse events of long-acting opioids in a state medicaid program. Annals of Pharmacotherapy, 41(6), 921-928. https://doi.org/10.1345/aph.1K066

Rates of adverse events of long-acting opioids in a state medicaid program. / Hartung, Daniel M.; Middleton, Luke; Haxby, Dean G.; Koder, Michele; Ketchum, Kathy L.; Chou, Roger.

In: Annals of Pharmacotherapy, Vol. 41, No. 6, 06.2007, p. 921-928.

Research output: Contribution to journalArticle

Hartung, DM, Middleton, L, Haxby, DG, Koder, M, Ketchum, KL & Chou, R 2007, 'Rates of adverse events of long-acting opioids in a state medicaid program', Annals of Pharmacotherapy, vol. 41, no. 6, pp. 921-928. https://doi.org/10.1345/aph.1K066
Hartung, Daniel M. ; Middleton, Luke ; Haxby, Dean G. ; Koder, Michele ; Ketchum, Kathy L. ; Chou, Roger. / Rates of adverse events of long-acting opioids in a state medicaid program. In: Annals of Pharmacotherapy. 2007 ; Vol. 41, No. 6. pp. 921-928.
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abstract = "BACKGROUND: Despite widespread use and emerging safety concerns, data on the comparative safety and effectiveness of long-acting opioid (LAO) analgesics are weak. OBJECTIVE: To compare rates of adverse events among patients newly prescribed an LAO. METHODS: A retrospective observational cohort study using Medicaid administrative claims data was conducted examining time until first adverse outcome among patients with new prescriptions for methadone, extended-release (ER) oxycodone, ER morphine, or transdermal fentanyl. Adverse outcomes included emergency department (ED) encounters or hospitalizations for opioid-related adverse events, all-cause ED encounters or hospitalizations, death, and diagnoses for opioid-related adverse effects. Cox proportional hazards models were used to adjust for a variety of measured covariates overall and within subgroups of patients with and without cancer. RESULTS: This study included 5684 subjects. Patients prescribed ER oxycodone were 35{\%} less likely (adjusted hazard ratio [HR] 0.45; 95{\%} CI 0.26 to 0.77) to experience an ED or hospitalization involving an opioid-related adverse event, 23{\%} lower risk of hospitalization (adjusted HR 0.77; 95{\%} CI 0.66 to 0.91), 41{\%} lower risk of constipation (adjusted HR 0.59; 95{\%} CI 0.35 to 1.00), and a 29{\%} lower risk of death (adjusted HR 0.71; 95{\%} CI 0.54 to 0.94) compared with those prescribed ER morphine. Among subjects with noncancer pain, fentanyl was associated with a higher risk of ED encounters (adjusted HR 1.27; 95{\%} Cl 1.02 to 1.59) and methadone was associated with a greater risk of overdose symptoms (adjusted HR 1.57; 95{\%} Cl 1.03 to 2.40) compared with ER morphine. CONCLUSIONS: Our results support a modest safety advantage with ER oxycodone compared with ER morphine. Among subjects with noncancer pain, fentanyl and methadone were associated with an increased risk of an adverse event compared with ER morphine. Additional studies are needed to confirm our findings and further clarify risks associated with different LAOs.",
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