(449) Pediatric opioid prescription rates for non-cancer pain: 2005-2014

PurposeTo determine time trends and characteristics associated with opioid analgesic prescribing to patients with cancer who are approaching the end of life.Patients and MethodsThis population-based cohort study used data on 29,825 patients diagnosed with five common cancers—lung (34.2%), colorectal (19.9%), female breast (21.6%), prostate (19.1%), and head and neck (5.2%)—in the United Kingdom General Practice Research Database (GPRD) who died between 2000 and 2008. Opioid prescription rates in the last 3 months of life were described. Characteristics associated with opioid prescribing were investigated by using generalized estimation equation models.ResultsIn the last 3 months of life, 43.6% (95% CI, 43.0% to 44.2%) of patients received at least one prescription of opioids: morphine (33.4%; 95% CI, 32.8% to 33.9%), diamorphine (11.6%; 95% CI, 11.2% to 11.9%), and fentanyl family (10.2%; 95% CI, 9.8% to 10.5%). Over time, prescription rates increased for opioids predominant during specific time periods, especially oxycodone. Older patients (age > 60 years) had significantly lower chances of receiving opioids than their younger (age < 50 years) peers (prevalence ratio [PR] range, 0.14 to 0.78), even adjusted for comorbidity. Women were slightly more likely than men to receive any type of opioid (PR,1.07; 95% CI, 1.04 to 1.11). Morphine and diamorphine (PR range, 1.14 to 1.56) were more commonly prescribed for lung and colorectal cancers and fentanyl family for head and neck cancers (PR, 1.39; 95% CI, 1.19 to 1.62) compared with for prostate cancers.ConclusionMorphine and diamorphine remain the stronghold for treating cancer pain in the United Kingdom. Opioid prescription rates are increasing over time. Prescription rates are lower for older people for all opioids, suggesting that this group needs attention.

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Postgraduate education and years of medical practice affect rate of opioid-prescription among physicians treating cancer pain

Journal of Pain and Symptom Management ◽

10.1016/s0885-3924(98)80056-0 ◽

1998 ◽

Vol 15 (4) ◽

pp. S17

Author(s):

M Bautz

Keyword(s):

Cancer Pain ◽

Medical Practice ◽

Postgraduate Education ◽

Opioid Prescription

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996. The Potential for Reducing Opioid and Analgesic Prescriptions Via Herpes Zoster Vaccination

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1182 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S527-S527

Author(s):

Jean-Etienne Poirrier ◽

Justin Carrico ◽

Jessica K DeMartino ◽

Katherine A Hicks ◽

Jeffrey J Stoddard ◽

...

Keyword(s):

Herpes Zoster ◽

Age Group ◽

Opioid Prescription ◽

Varicella Zoster ◽

Effectiveness Model ◽

Prescription Rates ◽

Medication Exposure ◽

The Mean ◽

The Impact ◽

Analgesic Use

Abstract Background Herpes zoster (HZ), or shingles, is a common neurocutaneous disease caused by the reactivation of latent varicella zoster virus that often includes rash and neuropathic pain that may last for months. Opioids and other analgesics may be prescribed. Recombinant zoster vaccine (RZV) is preferentially recommended for the prevention of HZ in adults aged 50 years and older. This study aimed to assess the impact of RZV vaccination on opioid and other analgesic prescription-related outcomes. Methods Estimates of analgesic prescription rates (opioids, benzodiazepines, and other analgesics) among HZ cases were established using Truven claims data from 2012-2018 for adults aged 50 years and older. HZ case avoidance with RZV vaccination was calculated using a previously published cost-effectiveness model. This data was included in a calculator assessing the impact of RZV vaccination on analgesic prescription-related outcomes (compared to no vaccination). Results Between 24.4% and 28.0% of HZ cases in the observed claims had at least one opioid prescription, dependent on age group (4.5%-6.5% and 8.6%-19.6% for benzodiazepines and other analgesics, respectively). The mean number of opioid prescriptions per person in each age group with at least one opioid prescription was between 1.7 and 1.9 (1.7-2.3 and 1.7-2.0 prescriptions for benzodiazepines and other analgesics, respectively). Assuming a 1-million-person population and 65% RZV coverage, the calculator predicts RZV vaccination will prevent 75,002 cases of HZ and will prevent 19,311 people from being prescribed at least 1 HZ-related opioid, 4,502 people from being prescribed benzodiazepines, and 12,201 people from being prescribed other analgesics. Additionally, 34,520 HZ-related opioid prescriptions will be avoided (9,413 benzodiazepine prescriptions; 22,406 other analgesic prescriptions). Conclusion HZ is associated with high levels of opioid, benzodiazepine, and other analgesic use. Primary prevention of HZ by vaccination could potentially reduce opioid and other medication exposure. Disclosures Jean-Etienne Poirrier, PhD, MBA, The GSK group of companies (Employee, Shareholder) Justin Carrico, BS, GlaxoSmithKline (Consultant) Jessica K. DeMartino, PhD, The GlaxoSmithKline group of companies (Employee, Shareholder) Katherine A. Hicks, MS, BSPH, GlaxoSmithKline (Scientific Research Study Investigator, GSK pays my company for my contractual services.) Saurabh P. Nagar, MS, RTI Health Solutions (Employee) Juliana Meyers, MA, GlaxoSmithKline (Other Financial or Material Support, This study was funded by GlaxoSmithKline.)

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Opioid availability statistics from the International Narcotics Control Board do not reflect the medical use of opioids: comparison with sales data from Scandinavia

Scandinavian Journal of Pain ◽

10.1515/sjpain-2021-0023 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Emmanuel Bäckryd ◽

Markus Heilig ◽

Mikael Hoffmann

Keyword(s):

Opioid Analgesics ◽

Warning Signal ◽

Control Board ◽

Opioid Use ◽

Opioid Prescription ◽

Sales Data ◽

Narcotics Control ◽

Addiction Risk ◽

The Usa ◽

Prescription Rates

Abstract Objectives Opioid analgesics are essential in clinical practice, but their excessive use is associated with addiction risk. Increases in opioid prescription rates have fuelled an epidemic of opioid addiction in the USA, making statistics on medical opioid use a critical warning signal. A dramatic 150% increase in Swedish opioid access 2001–2013 was recently reported based on data from the International Narcotics Control Board (INCB; Berterame et al. 2016) in conflict with other studies of opioid use in the Nordic countries. This article aims to analyse to what degree published INCB statistics on opioids in Scandinavia (Denmark, Norway and Sweden) reflect actual medical use and study the methodological reasons for putative discrepancies. Methods Data on aggregated total national sales of opioids for the whole population, including hospitals, were collected from the Swedish e-Health Authority. Total sales data for Denmark and drugs dispensed at pharmacies in Norway are publicly available through the relevant authorities’ websites. Results INCB opioid statistics during the period 2001–2013 were markedly inconsistent with sales data from Scandinavia, calling the reliability of INCB data into question. INCB-data were flawed by (a) over-representing the volume of fentanyl, (b) under-reporting of codeine, and (c) by not including tramadol. Conclusions Opioid availability, as expressed by INCB statistics, does not reflect medical opioid use. It is crucial to underline that INCB statistics are based on the manual compilation of national production, import and export data from manufacturers and drug companies. This is not the same amount that is prescribed and consumed within the health care system. Moreover, there are methodological problems in the INCB reports, in particular concerning fentanyl, codeine and tramadol. We suggest that INCB should carefully review the quality of their data on medical opioids.

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Implementing a Protocol to Reduce Opioid Prescriptions in Military Otolaryngology: A Quality Improvement Initiative

Military Medicine ◽

10.1093/milmed/usaa484 ◽

2021 ◽

Author(s):

CindyLee P Neighbors ◽

Michael W Noller ◽

Michael P Avillion ◽

John W Neighbors ◽

Mark C Spaw ◽

...

Keyword(s):

Retrospective Chart Review ◽

Outcome Variable ◽

Quality Improvement Initiative ◽

New Order ◽

Opioid Prescription ◽

Medication Refill ◽

Before And After ◽

Patient Pain ◽

Prescription Rates ◽

Order Set

ABSTRACT Introduction To compare pain medication refill rates for adult septoplasty and rhinoplasty patients before and after initiating a multimodal analgesic protocol for reducing opioid prescriptions (PROP). Materials and Methods Data from 58 adult patients were retrieved by retrospective chart review (19 septoplasties and 10 rhinoplasties before initiating PROP in September 2018 and 21 septoplasties and 8 rhinoplasties after PROP). We selected consecutive septoplasties and rhinoplasties, at which time a new discharge order set was implemented. The new order set consisted of 10 oxycodone tabs (5 mg), 100 acetaminophen tabs (325 mg), and 28 celecoxib tabs (200 mg). The primary outcome variable was the number of initial opioid prescriptions and refills filled by any provider. Results Among the septoplasties, there was a 46% decrease in total morphine milligram equivalent (MME) prescribed, from a mean of 202.0 mg in the non-PROP group (95% CI, 235.4, 174.6) to 108.6 mg in the PROP group (95% CI, 135.8, 81.4), with no difference in refill rates. Among the rhinoplasties, there was a 51% decrease in total MME prescribed, from a mean of 258.8 mg in the non-PROP group (95% CI, 333.4, 184.1) to 126.6 mg in the PROP group (95% CI, 168.1, 85.0) with no difference in refill rates. Conclusions The outcomes after PROP implementation for septoplasty and rhinoplasty at our institution suggest that opioid prescription rates can be significantly decreased to manage postoperative pain, with no difference in opioid refill rates. The results also warrant further investigation into patient pain, satisfaction, provider efficiency, and healthcare costs.

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Pain medication beliefs mediate the relationship between pain catastrophizing and opioid prescription use in patients with chronic non-cancer pain

Journal of Pain ◽

10.1016/j.jpain.2021.08.009 ◽

2021 ◽

Author(s):

Rachel. A. Elphinston ◽

Michael. J.L. Sullivan ◽

Michele. Sterling ◽

Jason. P. Connor ◽

John. A. Baranoff ◽

...

Keyword(s):

Cancer Pain ◽

Pain Catastrophizing ◽

Pain Medication ◽

Opioid Prescription ◽

Medication Beliefs ◽

The Relationship

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Opioid prescription rates and risk for substantiated child abuse and neglect: A Bayesian spatiotemporal analysis

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2019.107623 ◽

2019 ◽

Vol 205 ◽

pp. 107623

Author(s):

Matthew C. Morris ◽

Miriam Marco ◽

Brooklynn Bailey ◽

Ernesto Ruiz ◽

Wansoo Im ◽

...

Keyword(s):

Child Abuse ◽

Child Abuse And Neglect ◽

Spatiotemporal Analysis ◽

Opioid Prescription ◽

Abuse And Neglect ◽

Prescription Rates

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Is Opioid Prescribing Driving Trauma Recidivism or is Trauma Driving Opioid Use?

The American Surgeon ◽

10.1177/000313481908500618 ◽

2019 ◽

Vol 85 (6) ◽

pp. 567-571

Author(s):

Laura Harmon ◽

Leah Sukri ◽

Joseph A. Kufera ◽

Andrew Nguyen ◽

Meilin Grunnagle ◽

...

Keyword(s):

Injury Severity ◽

Hospital Admissions ◽

Traumatic Injury ◽

Previous History ◽

Significant Risk ◽

Significant Risk Factor ◽

Opioid Use ◽

Opioid Prescription ◽

Prescription Rates ◽

Trauma Recidivism

In the past 30 years, opioid prescription rates have quadrupled and hospital admissions for overdose are rising. Previous studies have focused on alcohol use and trauma recidivism, however rarely evaluating recidivism and opioid use. We hypothesized there is an association between opioid use and trauma recidivism. This is a retrospective review of patients with multiple admissions for traumatic injury. Demographics, opioid toxicology screen (TS) results, and injury characteristics were collected. Statistical analysis was performed with chi-squared and Poisson regression models. One thousand six hundred forty-nine patients (age ≥18 years) had multiple trauma admissions. Seven hundred nine patients had TS data for both admissions. Thirty-one per cent (218) were TS positive on the 1st admission compared with 34 per cent (244) on their 2nd admission. Fifty-five per cent of patients who were TS positive on the 1st admission were positive on their 2nd admission, whereas 25 per cent who were TS negative on the 1st admission were subsequently positive on their 2nd admission ( P < 0.0001). Patients who were TS positive on the subsequent admission were less severely injured than TS negative patients (Injury Severity Score > 15, 26.3% vs 22.3%, P = 0.04). The only significant risk factor for being TS positive on the 2nd admission was being TS positive on the 1st admission (relative risk = 2.18, P < 0.001). A previous history of opioid use is the strongest predictor of recurrent use in recidivists.

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