Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use

Objectives: Evaluate all-cause and endometriosis-related health care resource utilization and costs among newly diagnosed endometriosis patients with high-risk versus low-risk opioid use or patients with chronic versus non-chronic opioid use. Methods: A retrospective analysis of IBM MarketScan® Commercial Claims data from 2009 to 2018 was performed for females aged 18 to 49 with newly diagnosed endometriosis (International Classification of Diseases, Ninth Edition code: 617.xx; International Classification of Diseases, Tenth Edition code: N80.xx). Two sub-cohorts were identified: high-risk (⩾1 day with ⩾90 morphine milligram equivalents per day or ⩾1-day concomitant benzodiazepine use) or chronic opioid utilization (⩾90-day supply prescribed or ⩾10 opioid prescriptions). High-risk or chronic utilization was evaluated during the 12-month assessment period after the index date. Index date was the first opioid prescription within 12 months following endometriosis diagnosis. All outcomes were assessed over 12-month post-assessment period while adjusting for demographic and clinical characteristics. Results: Out of 61,019 patients identified, 18,239 had high-risk opioid use and 5001 chronic opioid use. Health care resource utilization drivers were outpatient visits and pharmacy fills, which were higher among high-risk versus low-risk patients (outpatient visits: 17.49 vs 15.51; pharmacy fills: 19.58 vs 16.88, p < 0.0001). Chronic opioid users had a higher number of outpatient visits (19.53 vs 15.00, p < 0.0001) and pharmacy fills (23.18 vs 16.43, p < 0.0001) compared to non-chronic opioid users. High-risk opioid users had significantly higher all-cause health care costs compared to low-risk opioid users (US$16,377 vs US$13,153; p < 0.0001). Chronic opioid users also had significantly higher all-cause health care costs compared to non-chronic opioid users (US$20,930 vs US$12,272; p < 0.0001). Similar patterns were observed among endometriosis-related HCRU, except pharmacy fills among high-risk and chronic sub-cohorts. Conclusion: This analysis demonstrates significantly higher all-cause and endometriosis-related health care resource utilization and total costs for high-risk opioid users compared to low-risk opioid users among newly diagnosed endometriosis patients over 1 year. Similar trends were observed for comparing chronic opioid users with non-chronic opioid users, except for endometriosis-related pharmacy fills and associated costs.

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Cannabis- Based Reduction in Opioid-Related Harms: Population-Based Observational Meta-Analysis

10.21203/rs.3.rs-25299/v1 ◽

2020 ◽

Author(s):

Isabella Kathleen MacMillan ◽

Kevin M Gorey

Keyword(s):

Harm Reduction ◽

Meta Analysis ◽

Medical Marijuana ◽

State Level ◽

Population Based ◽

Opioid Overdose ◽

Opioid Use ◽

Marijuana Legalization ◽

The Usa ◽

Recreational Marijuana

Abstract Background. Rhetoric abounds about harms associated with easier access to cannabis. Yet, surveys of medical marijuana patients and recreational users in Canada and the USA observed that they prevalently substitute cannabis for alcohol, opioids and other drugs. This synthetic study focused on arguably the most harmful substance, opioids, and hypothesized reduced harms with medical and recreational cannabis legalization. Methods. Broad keyword searches of interdisciplinary research databases, peer-reviewed and gray, between 2010 and 2020 retrieved 11 studies. Their outcomes were synthesized with a sample-weighted meta-analysis that compared opioid-related outcomes before and after marijuana legalization in states that legalized marijuana versus those that had not.Results. All but one of the primary studies supported the marijuana protection or harm reduction hypothesis. In aggregate and controlling for typically eight state-level covariates, risks associated with opioid use diminished by 7% (RR = 0.93, 95% CI 0.92, 0.94) after legalization; 7% after medical marijuana and 35% after recreational marijuana legalization (p < .05). Opioid prescriptions decreased by 8% and opioid overdose mortality diminished by 25% after medical marijuana legalization. Both were further diminished after recreational marijuana was legalized. Conclusions. Their potential public health significances is clear, suggesting that such legislation profoundly affects the behaviors of physicians, patients and addicts in protective ways. However, all the studies, thus far, have been state-level, ecological analyses. Further multilevel and clinic-based analyses in ought to be accomplished to systematically replicate (or refute) this study’s harm reduction estimates and to put them into clinical practice where indicated.

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Predictors of Chronic Opioid Use: A Population-level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djab082 ◽

2021 ◽

Author(s):

Devon K Check ◽

Christopher D Bagett ◽

KyungSu Kim ◽

Andrew W Roberts ◽

Megan C Roberts ◽

...

Keyword(s):

North Carolina ◽

Substance Use ◽

Cancer Survivors ◽

Low Income ◽

Opioid Therapy ◽

Adjusted Relative Risk ◽

Opioid Use ◽

Chronic Opioid Therapy ◽

Increased Risk ◽

Chronic Opioid Use

Abstract Background No population-based studies have examined chronic opioid use among cancer survivors who are diverse with respect to diagnosis, age group, and insurance status. Methods We conducted a retrospective cohort study using North Carolina (NC) cancer registry data linked with claims from public and private insurance (2006–2016). We included adults with non-metastatic cancer who had no prior chronic opioid use (N = 38,366). We used modified Poisson regression to assess the adjusted relative risk of chronic opioid use in survivorship (>90-day continuous supply of opioids in the 13–24 months following diagnosis) associated with patient characteristics. Results Only 3.0% of cancer survivors in our cohort used opioids chronically in survivorship. Predictors included younger age (adjusted risk ratio [aRR], 50–59 vs 60–69 = 1.23, 95% confidence interval [CI] = 1.05–1.43), baseline depression (aRR = 1.22, 95% CI = 1.06–1.41) or substance use (aRR = 1.43, 95% CI = 1.15–1.78) and Medicaid (aRR vs Private = 1.93, 95% CI = 1.56–2.40). Survivors who used opioids intermittently (vs not at all) before diagnosis were twice as likely to use opioids chronically in early survivorship (aRR = 2.62, 95% CI = 2.28–3.02). Those who used opioids chronically (vs intermittently or not at all) during active treatment had a nearly 17-fold increased likelihood of chronic use in survivorship (aRR = 16.65, 95 CI = 14.30–19.40). Conclusions Younger and low-income survivors, those with baseline depression or substance use, and those who require chronic opioid therapy during treatment are at increased risk for chronic opioid use in survivorship. Our findings point to opportunities improve assessment of psychosocial histories and to engage patients in shared decision-making around long-term pain management, when chronic opioid therapy is required during treatment.

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Treatment approaches and outcome trajectories for youth with high‐risk opioid use: A narrative review

Early Intervention in Psychiatry ◽

10.1111/eip.13155 ◽

2021 ◽

Author(s):

Jean Nicolas Westenberg ◽

Andy M. Y. Tai ◽

Julie Elsner ◽

Mostafa M. Kamel ◽

James S. H. Wong ◽

...

Keyword(s):

High Risk ◽

Narrative Review ◽

Opioid Use ◽

Treatment Approaches

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Chronic opioid use modulates human enteric microbiota and intestinal barrier integrity

Gut Microbes ◽

10.1080/19490976.2021.1946368 ◽

2021 ◽

Vol 13 (1) ◽

pp. 1946368

Author(s):

Angélica Cruz-Lebrón ◽

Ramona Johnson ◽

Claire Mazahery ◽

Zach Troyer ◽

Samira Joussef-Piña ◽

...

Keyword(s):

Intestinal Barrier ◽

Opioid Use ◽

Barrier Integrity ◽

Intestinal Barrier Integrity ◽

Chronic Opioid Use

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Sa180 CHRONIC OPIOID USE IN OPIOID INDUCED ESOPHAGEAL DYSFUNCTION: DOSE AND GENDER EFFECTS

Gastroenterology ◽

10.1016/s0016-5085(21)01793-5 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-453-S-454

Author(s):

Neil Sood ◽

Neil Nadpara ◽

Dariush Shahsavari ◽

Henry P. Parkman ◽

Zubair A. Malik

Keyword(s):

Gender Effects ◽

Opioid Use ◽

Esophageal Dysfunction ◽

Chronic Opioid Use ◽

And Gender

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Geographic Variation of High-Risk Opioid Use and Risk of Overdose Among Disabled Medicare Beneficiaries in the US from 2011 to 2015

Value in Health ◽

10.1016/j.jval.2018.04.076 ◽

2018 ◽

Vol 21 ◽

pp. S2

Author(s):

W Lo-Ciganic ◽

WF Gellad ◽

L Zhou ◽

JM Donohue ◽

A Roubal ◽

...

Keyword(s):

High Risk ◽

Geographic Variation ◽

Medicare Beneficiaries ◽

Opioid Use ◽

The Us

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Characteristics of Opioid Prescriptions to Veterans With Chronic Gastrointestinal Symptoms and Disorders Dually Enrolled in the Department of Veterans Affairs and Medicare Part D

Military Medicine ◽

10.1093/milmed/usab095 ◽

2021 ◽

Author(s):

Salva N Balbale ◽

Lishan Cao ◽

Itishree Trivedi ◽

Jonah J Stulberg ◽

Katie J Suda ◽

...

Keyword(s):

Gastrointestinal Symptoms ◽

Medicare Part D ◽

Medicare Part ◽

Opioid Use ◽

Opioid Prescription ◽

Part D ◽

Gi Symptoms ◽

Chronic Opioid Use ◽

Multiple Logistic Regression Modeling ◽

Chronic Use

ABSTRACT Introduction Gastrointestinal (GI) symptoms and disorders affect an increasingly large group of veterans. Opioid use may be rising in this population, but this is concerning from a patient safety perspective, given the risk of dependence and lack of evidence supporting opioid use to manage chronic pain. We examined the characteristics of opioid prescriptions and factors associated with chronic opioid use among chronic GI patients dually enrolled in the DVA and Medicare Part D. Materials and Methods In this retrospective cohort study, we used linked, national patient-level data (from April 1, 2011, to December 31, 2014) from the VA and Centers for Medicare & Medicaid Services to identify chronic GI patients and observe opioid use. Veterans who had a chronic GI symptom or disorder were dually enrolled in VA and Part D and received ≥1 opioid prescription dispensed through the VA, Part D, or both. Chronic GI symptoms and disorders included chronic abdominal pain, chronic pancreatitis, inflammatory bowel diseases, and functional GI disorders. Key outcome measures were outpatient opioid prescription dispensing overall and chronic opioid use, defined as ≥90 consecutive days of opioid receipt over 12 months. We described patient characteristics and opioid use measures using descriptive statistics. Using multiple logistic regression modeling, we generated adjusted odds ratios and 95% CIs to determine variables independently associated with chronic opioid use. The final model included variables outlined in the literature and our conceptual framework. Results We identified 141,805 veterans who had a chronic GI symptom or disorder, were dually enrolled in VA and Part D, and received ≥1 opioid prescription dispensed from the VA, Part D, or both. Twenty-six percent received opioids from the VA only, 69% received opioids from Medicare Part D only, and 5% were “dual users,” receiving opioids through both VA and Part D. Compared to veterans who received opioids from the VA or Part D only, dual users had a greater likelihood of potentially unsafe opioid use outcomes, including greater number of days on opioids, higher daily doses, and higher odds of chronic use. Conclusions Chronic GI patients in the VA may be frequent users of opioids and may have a unique set of risk factors for unsafe opioid use. Careful monitoring of opioid use among chronic GI patients may help to begin risk stratifying this group. and develop tailored approaches to minimize chronic use. The findings underscore potential nuances within the opioid epidemic and suggest that components of the VA’s Opioid Safety Initiative may need to be adapted around veterans at a higher risk of opioid-related adverse events.

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Patterns and Impact of Electronic Health Records-Defined Depression Phenotypes in Spine Surgery

Neurosurgery ◽

10.1093/neuros/nyab096 ◽

2021 ◽

Author(s):

Maxwell Boakye ◽

Mayur Sharma ◽

Shawn Adams ◽

Thomas Chandler ◽

Dengzhi Wang ◽

...

Keyword(s):

Resource Utilization ◽

Spine Surgery ◽

Healthcare Resource Utilization ◽

Care Utilization ◽

Complication Rates ◽

Psychiatric Condition ◽

Opioid Use ◽

International Classification Of Disease ◽

Chronic Opioid Use ◽

Poor Outcomes

Abstract BACKGROUND Preoperative depression is a risk factor for poor outcomes after spine surgery. OBJECTIVE To understand effects of depression on spine surgery outcomes and healthcare resource utilization. METHODS Using IBM’s MarketScan Database, we identified 52 480 patients who underwent spinal fusion. Retained patients were classified into 6 depression phenotype groups based on International Classification of Disease, 9th/10th Revision (ICD-9/10) codes and use/nonuse of antidepressant medications: major depressive disorder (MDD), other depression (OthDep), antidepressants for other psychiatric condition (PsychRx), antidepressants for physical (nonpsychiatric) condition (NoPsychRx), psychiatric condition only (PsychOnly), and no depression (NoDep). We analyzed baseline demographics, comorbidities, healthcare utilization/payments, and chronic opioid use. RESULTS Breakdown of groups in our cohort: MDD (15%), OthDep (12%), PsychRx (13%), NonPsychRx (15%), PsychOnly (12%), and NoDep (33%). Postsurgery: increased outpatient resource utilization, admissions, and medication refills at 1, 2, and 5 yr in the NoDep, PsychOnly, NonPsychRx, PsychRx, and OthDep groups, and highest in MDD. Postoperative opioid usage rates remained unchanged in MDD (44%) and OthDep (36%), and reduced in PsychRx (40%), NonPsychRx (31%), and PsychOnly (20%), with greatest reduction in NoDep (13%). Reoperation rates: 1 yr after index procedure, MDD, OthDep, PsychRx, NonPsychRx, and PsychOnly had more reoperations compared to NoDep, and same at 2 and 5 yr. In NoDep patients, 45% developed new depressive phenotype postsurgery. CONCLUSION EHR-defined classification allowed us to study in depth the effects of depression in spine surgery. This increased understanding of the interplay of mental health will help providers identify cohorts at risk for high complication rates, and health care utilization.

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