Codeine Shopping Behavior in a Retrospective Cohort of Chronic Noncancer Pain Patients: Incidence and Risk Factors

Background: This study sought to characterize the real-world treatment of chronic noncancer pain (CNCP) in patients on opioid therapy in primary care. Methods: A retrospective cohort study from 2014-18 was conducted at a multidisciplinary primary care clinic in Chilliwack, British Columbia. Included were adults on daily opioid therapy for CNCP. Patients receiving palliative care or ≤1 visit were excluded. Outcomes of interest included use of opioid/nonopioid pharmacotherapy, number/frequency of visits and proportion of patients able to reduce/discontinue opioid therapy. Results: Seventy patients (mean age 53 years, 53% male, 51% back pain) were included. Median follow-up was 6 visits over 12 months. Sixty-two patients (89%) reduced their opioid dose, 6 patients had no change and 2 patients required a dose increase. Mean opioid dose was reduced from 183 to 70 mg morphine equivalents daily. Twenty-four patients (34%) discontinued opioid therapy, 6 patients (9%) transitioned to opioid agonist therapy and 6 patients (9%) breached their opioid treatment agreement. Nonopioid pharmacotherapy included nonsteroidal anti-inflammatory drugs (64%), gabapentinoids (63%), tricyclic antidepressants (56%) and nabilone (51%). Discussion: Over half of patients were no longer on opioid therapy by the end of the study. Most patients had a disorder (e.g., back pain) for which opioids are generally not recommended. Overall mean opioid dose was reduced from baseline by approximately 60% over 1 year. Lack of access to specialized pain treatments may have accounted for high nonopioid pharmacotherapy usage. Conclusions: This study demonstrates that treatment of CNCP and opioid tapering can successfully be achieved in a primary care setting. Can Pharm J (Ott) 2020;153:xx-xx.

Download Full-text

Efficacy and Practicality of Opioid Therapy in Japanese Chronic Noncancer Pain Patients

Pain Management Nursing ◽

10.1016/j.pmn.2018.09.010 ◽

2019 ◽

Vol 20 (3) ◽

pp. 222-231 ◽

Cited By ~ 1

Author(s):

Yukari Shindo ◽

Soushi Iwasaki ◽

Michiaki Yamakage

Keyword(s):

Opioid Therapy ◽

Chronic Noncancer Pain ◽

Noncancer Pain ◽

Pain Patients

Download Full-text

Health care resource use and cost differences by opioid therapy type among chronic noncancer pain patients

Journal of Pain Research ◽

10.2147/jpr.s130913 ◽

2017 ◽

Vol Volume 10 ◽

pp. 1713-1722 ◽

Cited By ~ 2

Author(s):

Pamela Landsman-Blumberg ◽

Nathaniel Katz ◽

Kavita Gajria ◽

Anna D’Souza ◽

Sham L Chaudhari ◽

...

Keyword(s):

Health Care ◽

Resource Use ◽

Opioid Therapy ◽

Health Care Resource ◽

Chronic Noncancer Pain ◽

Health Care Resource Use ◽

Noncancer Pain ◽

Pain Patients ◽

Cost Differences

Download Full-text

Assessing Cognitive and Psychomotor Performance Under Long-Term Treatment with Transdermal Buprenorphine in Chronic Noncancer Pain Patients

Anesthesia & Analgesia ◽

10.1213/01.ane.0000281078.65585.1e ◽

2007 ◽

Vol 105 (5) ◽

pp. 1442-1448 ◽

Cited By ~ 32

Author(s):

Oguzhan Dagtekin ◽

Hans J. Gerbershagen ◽

Werner Wagner ◽

Frank Petzke ◽

Lukas Radbruch ◽

...

Keyword(s):

Psychomotor Performance ◽

Term Treatment ◽

Chronic Noncancer Pain ◽

Long Term Treatment ◽

Noncancer Pain ◽

Pain Patients

Download Full-text

Long-term opioid users with chronic noncancer pain: Assessment of opioid abuse risk and relationship with healthcare resource use

Journal of Opioid Management ◽

10.5055/jom.2018.0440 ◽

2018 ◽

Vol 14 (2) ◽

pp. 131 ◽

Cited By ~ 6

Author(s):

Anna D. Coutinho, BPharm, PhD ◽

Kavita Gandhi, BPharm, MS ◽

Rupali M. Fuldeore, BAMS, MS ◽

Pamela B. Landsman-Blumberg, MPH, DrPH ◽

Sanjay Gandhi, PhD

Keyword(s):

Risk Factors ◽

At Risk ◽

Opioid Abuse ◽

Low Risk ◽

Chronic Noncancer Pain ◽

Cart Analysis ◽

Risk Patients ◽

Noncancer Pain ◽

Abuse Risk

Objective: Identify opioid abuse risk factors among chronic noncancer pain (CNCP) patients receiving long-term opioid therapy and assess healthcare resource use (HRU) among patients at elevated abuse risk.Design: Data were obtained from an integrated administrative claims database. Classification and Regression Tree (CART) analysis identified risk factors potentially predictive of opioid abuse, which were used to classify the overall population into cohorts defined by levels of abuse risk. Multivariable logistic regression compared HRU across risk cohorts.Setting: Retrospective cohort study.Patients, participants: 21,072 patients aged ≥18 years diagnosed with ≥1 of 5 types of CNCP and a prescription for Schedule II or III/IV opioid medication used long-term (≥90 days).Main outcome measures: (1) Opioid abuse risk factors; (2) HRU differences between risk cohorts.Results: CART analysis identified four groups at elevated opioid abuse risk defined by three factors (age, daily opioid dose, and total days’ supply of opioids); sensitivity: 70.3 percent, specificity: 74.1 percent, and positive predictive value: 5.6 percent. The analysis results were used to classify patients into low-risk (72.5 percent), at-risk (25.4 percent), and opioid-abuser (2.2 percent) cohorts. In multivariable analysis, emergency department (ED) use was higher among at-risk vs low-risk patients (odds ratio [OR]: 1.14; p < 0.05); hospitalization and ED visits were higher for opioid-abusers vs low-risk patients (OR: 2.33 and 2.14, respectively; p < 0.05).Conclusions: This study identifies a subpopulation of CNCP patients at risk of opioid abuse. However, limited sensitivity and specificity of criteria defining this subpopulation reinforce the importance of physician discretion in patient-level treatment decisions.

Download Full-text