Trends in opioid prescribing in Australia: a systematic review

2020 ◽  
Vol 44 (2) ◽  
pp. 277
Author(s):  
Peter J. Donovan ◽  
David Arroyo ◽  
Champika Pattullo ◽  
Anthony Bell
Keyword(s):  
Historical Data ◽  
Grey Literature ◽  
Risk Of Bias ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Policy Makers ◽  
Opioid Prescribing ◽  
Prevalence Estimates ◽  
Prescription Opioid Use

Objective This review systematically identified studies that estimated the prevalence of prescription opioid use in Australia, assessed the prevalence estimates for bias and identified areas for future research. Methods Literature published after 2000 containing a potentially representative estimate of prescription opioid use in adults, in the community setting, in Australia was included in this review. Studies that solely assessed opioid replacement, illicit opioid usage or acute hospital in-patient use were excluded. Databases searched included PubMed, EMBASE, Web of Science and the grey literature. Results The search identified 2253 peer-reviewed publications, with 34 requiring full-text review. Of these, 20 were included in the final qualitative analysis, in addition to four publications from the grey literature. Most studies included analysed prescription claims data for medicines dispensed via Australia’s national medicines subsidy scheme (the Pharmaceutical Benefits Scheme). Although data sources were good quality, all prevalence estimates were at least at moderate risk of bias, predominantly due to incompleteness of data or potential confounding. Included publications demonstrated a significant rise in opioid use up to 2017 (including a 15-fold increase in prescriptions dispensed over the 20 years to 2015), predominantly driven by a sharp rise in oxycodone use. Although opioid prescription numbers continue to escalate, usage, as measured by oral morphine equivalent per capita, may have plateaued since 2014. Codeine remains the most prevalently obtained opioid, followed by oxycodone and tramadol. There was a substantial delay (median 30 months; interquartile range 20–37 months) to publication of opioid usage data from time of availability. Conclusions Australia has experienced a marked increase in opioid prescribing since the 1990s. Current published literature is restricted to incomplete, delayed and historical data, limiting the ability of clinicians and policy makers to intervene appropriately. What is known about the topic? Opioid prescriptions in Australia have continued to increase since the 1990s and may be mirroring the epidemic being seen in the US. What does this paper add? This paper systematically identifies all publications that have examined the prevalence of prescription opioid use in Australia since 2000, and only identified prevalence estimates that were at moderate or high risk of bias, and found significant delays to publication of these estimates. What are the implications for practitioners? Because published literature on the prevalence of prescription opioid consumption is restricted to incomplete, delayed and historical data, the ability of clinicians and policy makers to appropriately intervene to curb prescription opioid use is limited. A national policy of real-time monitoring and reporting of opioid prescribing may support improvements in practice.

scholarly journals Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Daniel M. Hartung ◽  
Jonah Geddes ◽  
Sara E. Hallvik ◽  
P. Todd Korthuis ◽  
Luke Middleton ◽  
...  
Keyword(s):  
Performance Improvement ◽  
Emergency Department Visits ◽  
Prescription Opioid ◽  
High Dose ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Improvement Project ◽  
Opioid Prescribing ◽  
Percentage Points ◽  
Prescription Opioid Use

Abstract Background In 2015, Oregon’s Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). The objective of this study was to evaluate the effect of that program on prescription opioid use and outcomes. Methods Using Medicaid claims data from 2014 to 2017, we conducted interrupted time-series analyses to examine changes in the prescription opioid use and overdose rates before (July 2014 to June 2015) and after (January 2016 to December 2017) implementation of Oregon’s high-dose policy initiative (July 2015 to December 2015). Prescribing outcomes were: 1) total opioid prescriptions 2) high-dose [> 90 morphine milligram equivalents per day] opioid prescriptions, and 3) proportion of opioid prescriptions that were high-dose. Opioid overdose outcomes included emergency department visits or hospitalizations that involved an opioid-related poisoning (total, heroin-involved, non-heroin involved). Analyses were performed at the state and CCO level. Results There was an immediate reduction in high dose opioid prescriptions after the program was implemented (− 1.55 prescription per 1000 enrollee; 95% CI − 2.26 to − 0.84; p < 0.01). Program implementation was also associated with an immediate drop (− 1.29 percentage points; 95% CI − 1.94 to − 0.64 percentage points; p < 0.01) and trend reduction (− 0.23 percentage point per month; 95% CI − 0.33 to − 0.14 percentage points; p < 0.01) in the monthly proportion of high-dose opioid prescriptions. The trend in total, heroin-involved, and non-heroin overdose rates increased significantly following implementation of the program. Conclusions Although Oregon’s high-dose opioid performance improvement project was associated with declines in high-dose opioid prescriptions, rates of opioid overdose did not decrease. Policy efforts to reduce opioid prescribing risks may not be sufficient to address the growing opioid crisis.

P133 PRESCRIPTION OPIOID USE AMONG VETERANS WITH INFLAMMATORY BOWEL DISEASE

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S27-S27
Author(s):  
Bryan Love ◽  
Christopher Finney ◽  
Jill Gaidos
Keyword(s):  
Health Care ◽  
Prescription Opioid ◽  
First Year ◽  
Diagnostic Code ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Medical Diagnoses ◽  
Health Care Encounters ◽  
Va Health Care System ◽  
Prescription Opioid Use

Abstract Background Opioids are commonly prescribed to manage pain in patients with IBD despite increasing evidence of harm associated with chronic use. The aim of the current study was to describe trends in opioid use among veterans with IBD. Methods This was a retrospective cohort study derived from the Veterans Affairs (VA) Health Care System. A unique patient identifier facilitated longitudinal evaluation of electronic databases that include medical diagnoses, surgical procedures, pharmaceuticals, labs, vital status information, dates of treatment, and radiology findings. Veterans were labeled as having IBD if there were at least 2 outpatient or 1 inpatient health care encounters with an ICD-9/10 diagnostic code consistent with IBD from fiscal years 2002 to 2016. Veterans without a minimum of 2 years of follow-up or who had a cancer diagnosis within 1 year before or after IBD diagnosis were excluded. In order to standardize the quantity of opioid exposure, morphine milligram equivalents (MME) for each prescription was calculated using published conversion factors. Individual prescriptions with missing quantity or day’s supply and prescriptions exceeding 1000 MME/day were excluded. Opioid exposure during the first year following the initial diagnosis date was determined as the average MME/day for those with at least one opioid prescription. Annual opioid prescribing rates per 100 IBD patients were calculated. Comorbidities were assessed using a modified Charlson Comorbidity Index (CCI), excluding cancer from the calculation. Results During the study period, 65,817 veterans with IBD were identified. The majority were males (92.1%), Caucasian (78.2%), and had a mean age of 58.2 years. In total, 1,471,019 individual opioid prescriptions were evaluated. The quantity and rate of opioid prescriptions peaked in 2012, with 115,774 unique prescriptions and 698.5 opioid prescriptions per 100 IBD patients, respectively. Twenty-seven percent (n=17,844) of IBD patients had at least one opioid prescription within the initial year of diagnosis. Mean opioid exposure during the initial year of diagnosis averaged 33.2 MME/day, and 12.2% had mean opioid exposure greater than 50 MME/day. Opioid exposure peaked in 2005 at 37.4 MME/day and consistently declined to 29.3 MME/day in 2016. Conclusion There has been a significant decline in opioid prescriptions, prescribing rate, and mean opioid exposure since peaking in 2012. These trends are similar to those seen in the non-veteran US population.

scholarly journals The cost of pain

2018 ◽  
Vol 87 (1) ◽  
pp. 71-72 ◽  
Author(s):  
Adam Beswick ◽  
Caroline Piccininni
Keyword(s):  
Addiction Treatment ◽  
Management Strategies ◽  
Cost Effective ◽  
Prescription Opioid ◽  
Regular Component ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Economic Implications ◽  
Program Costs ◽  
Prescription Opioid Use

Prescription opioid use has historically been a regular component of the management of chronic nonmalignant pain in Canada. However, the economic implications of high rates of addiction and abuse have motivated consideration of more cost-effective management strategies for chronic pain. The economic burden imposed by prescription opioid use relates in part to lost workplace productivity, increased addiction treatment program costs, and increased overall healthcare expenditure for these patients. In this article, we present research on the economic implications of the current rates of opioid prescription, and report on the specific economic advantages realized in alternative therapeutic approaches to pain management.

scholarly journals Chronic High Risk Prescription Opioid Use Among Persons With HIV

2021 ◽  
Vol 6 ◽  
Author(s):  
Ana Ventuneac ◽  
Gavriella Hecht ◽  
Emily Forcht ◽  
Bianca A. Duah ◽  
Shafaq Tarar ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
High Risk ◽  
Substance Use Disorders ◽  
Prescribing Patterns ◽  
Hiv Care ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Opioid Prescribing ◽  
Prescription Opioid Use

Persons with HIV (PWH) are a population at risk for adverse sequelae of opioid use. Yet, few studies have examined correlates of chronic high risk opioid use and its impact on HIV outcomes. Trends in prescribing patterns and identification of factors that impact the use of opioid prescriptions among PWH are crucial to determine prevention and treatment interventions. This study examined electronic medical records (EMR) of patients receiving HIV care to characterize prescribing patterns and identify risk factors for chronic high risk prescription opioid use and the impact on HIV outcomes among PWH in primary care from July 1, 2016–December 31, 2017. EMR were analyzed from 8,882 patients who were predominantly male and ethnically and racially diverse with half being 50 years of age or older. The majority of the 8,744 prescriptions (98% oral and 2% transdermal preparations) given to 1,040 (12%) patients were oxycodone (71%), 8% were morphine, 7% tramadol, 4% hydrocodone, 4% codeine, 2% fentanyl, and 4% were other opioids. The number of monthly prescriptions decreased about 14% during the study period. Bivariate analyses indicated that most demographic and clinical variables were associated with receipt of any opioid prescription. After controlling for patient socio-demographic characteristics and clinical factors, the odds of receipt of any prescription were higher among patients with pain diagnoses and opioid use and mental health disorders. In addition, the odds of receipt of high average daily morphine equivalent dose (MED) prescriptions were higher for patients with pain diagnoses. Lastly, patients with substance use disorders (SUD) had an increased likelihood of detectable viral load compared to patients with no SUD, after adjusting for known covariates. Our findings show that despite opioid prescribing guidelines and monitoring systems, additional efforts are needed to prevent chronic high risk prescriptions in patients with comorbid conditions, including pain-related, mental health and substance use disorders. Evidence about the risk for chronic high risk use based on prescribing patterns could better inform pain management and opioid prescribing practices for patients receiving HIV care.

scholarly journals Association between initial opioid prescription diagnosis type and subsequent chronic prescription opioid use in Rhode Island: a population-based cohort study

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e050540
Author(s):  
Benjamin D Hallowell ◽  
Laura C Chambers ◽  
Luke Barre ◽  
Nancy Diao ◽  
Collette Onyejekwe ◽  
...  
Keyword(s):  
Cohort Study ◽  
Rhode Island ◽  
Population Based ◽  
Primary Outcome Measure ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Management Approaches ◽  
Opioid Users ◽  
Prescription Opioid Use

ObjectiveTo identify initial diagnoses associated with elevated risk of chronic prescription opioid use.DesignPopulation-based, retrospective cohort study.SettingState of Rhode Island.ParticipantsRhode Island residents with an initial opioid prescription dispensed between 1 April 2019 and 31 March 2020.Primary outcome measureSubsequent chronic prescription opioid use, defined as receiving 60 or more days’ supply of opioids in the 90 days following an initial opioid prescription.ResultsAmong the 87 055 patients with an initial opioid prescription, 3199 (3.7%) subsequently became chronic users. Patients who become chronic users tended to receive a longer days’ supply, greater quantity dispensed, but a lower morphine milligram equivalents on the initial opioid prescription. Patients prescribed an initial opioid prescription for diseases of the musculoskeletal system and connective tissue (adjusted OR (aOR): 5.9, 95% CI: 4.7 to 7.6), diseases of the nervous system (aOR: 6.3, 95% CI: 4.9 to 8.0) and neoplasms (aOR: 5.6, 95% CI: 4.2 to 7.5) had higher odds of subsequent chronic prescription opioid use, compared with a referent group that included all diagnosis types with fewer than 15 chronic opioid users, after adjusting for confounders.ConclusionsBy focusing interventions and prescribing guidelines on specific types of diagnoses that carry a high risk of chronic prescription opioid use and diagnoses that would benefit equally or more from alternative management approaches, states and healthcare organisations may more efficiently decrease inappropriate opioid prescribing while improving the quality of patient care.

Prescription opioid use among drivers in British Columbia, 1997–2016

2021 ◽  
pp. injuryprev-2020-043989
Author(s):  
John A Staples ◽  
Shannon Erdelyi ◽  
Jessica Moe ◽  
Mayesha Khan ◽  
Herbert Chan ◽  
...  
Keyword(s):  
British Columbia ◽  
Geographical Variation ◽  
Temporal Trends ◽  
Population Based ◽  
Opioid Consumption ◽  
Prescription Opioid ◽  
Prescription Data ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Prescription Opioid Use

BackgroundOpioids increase the risk of traffic crash by limiting coordination, slowing reflexes, impairing concentration and producing drowsiness. The epidemiology of prescription opioid use among drivers remains uncertain. We aimed to examine population-based trends and geographical variation in drivers’ prescription opioid consumption.MethodsWe linked 20 years of province-wide driving records to comprehensive population-based prescription data for all drivers in British Columbia (Canada). We calculated age- and sex-standardised rates of prescription opioid consumption. We assessed temporal trends using segmented linear regression and examined regional variation in prescription opioid use using maps and graphical techniques.ResultsA total of 46 million opioid prescriptions were filled by 3.0 million licensed drivers between 1997 and 2016. In 2016 alone, 14.7% of all drivers filled at least one opioid prescription. Prescription opioid use increased from 238 morphine milligram equivalents per driver year (MMEs/DY) in 1997 to a peak of 834 MMEs/DY in 2011. Increases in MMEs/DY were greatest for higher potency and long-acting prescription opioids. The interquartile range of prescription opioid dispensation by geographical region increased from 97 (Q1=220, Q3=317) to 416 (Q1=591, Q3=1007) MMEs/DY over the study interval.ImplicationsPatterns of prescription opioid consumption among drivers demonstrate substantial temporal and geographical variation, suggesting they may be modified by clinical and policy interventions. Interventions to curtail use of potentially impairing prescription medications might prevent impaired driving.

Characteristics of postoperative opioid prescription use following lumbar discectomy

2021 ◽  
pp. 1-5
Author(s):  
Chason Ziino ◽  
Aditya V. Karhade ◽  
Andrew J. Schoenfeld ◽  
Mitchel B. Harris ◽  
Joseph H. Schwab
Keyword(s):  
Poisson Regression ◽  
Predictor Variable ◽  
Primary Diagnosis ◽  
Lumbar Discectomy ◽  
Independent Effect ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Prescription Opioid Use

OBJECTIVE The role of spine surgeons in precipitating and mediating sustained prescription opioid use remains controversial at this time. The purpose of this study was to identify prescription opioid use following lumbar discectomy and characterize the source of opioid prescriptions by clinician specialty (surgeon vs nonsurgeon). METHODS Using a retrospective review, the authors identified adult patients undergoing lumbar discectomy for a primary diagnosis of disc herniation between 2010 and 2017. The primary outcome was sustained prescription opioid use, defined as issue of an opioid prescription at a time point 90 days or longer after the surgical procedure. The primary predictor variable was prescriber specialty (surgeon vs nonsurgeon). The independent effect of provider specialty on the number of opioid prescriptions issued to patients was assessed using multivariable Poisson regression that accounted for confounding from all other clinical and sociodemographic variables. RESULTS This study included 622 patients who underwent a lumbar discectomy. A total of 610 opioid prescriptions were dispensed for this population after surgery. In total, 126 patients (20.3%) had at least one opioid prescription in the period beyond 90 days following their surgery. The majority of opioid prescriptions, 494 of 610 (81%), were non–inpatient prescriptions. Among these, only a minority (26%) of outpatient opioid prescriptions were written by surgical providers. Following multivariable Poisson regression analysis, surgical providers were found to have a lower likelihood of issuing an opioid prescription compared to nonsurgical clinicians (incidence rate ratio [IRR] 0.78; 95% CI 0.68–0.89; p = 0.001). CONCLUSIONS A minority of lumbar discectomy patients continue to receive opioid prescriptions up to 15 months after surgery. Many of these prescriptions are written by nonsurgical providers unaffiliated with the operative team.

scholarly journals Text Fingerprinting and Topic Mining in the Prescription Opioid Use Literature

2021 ◽  
Author(s):  
Huyen Le ◽  
Junxiu Zhou ◽  
Weizhong Zhao ◽  
Roger Perkins ◽  
Weigong Ge ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Effects ◽  
Topic Modeling ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Related Literature ◽  
Medical Disorders ◽  
Word Clouds ◽  
Prescription Opioid Use

Abstract Background Prescription opioids are powerful pain-reducing medications, but they may cause a variety of adverse effects. Long-term prescription opioid use (POU) is contributing to an opioid-related epidemic of addiction and death, and the scope of the opioid crisis continues to expand. As such, there is a need to identify the adverse effects associated with prescription opioid use (POU). Thousands of articles that focus on POU and its associated medical disorders have been published. However, it is time-consuming and labor-intensive to extract and understand the information of all POU-related published articles.Methods In this study, we applied the well-adapted topic modeling method, Latent Dirichlet Allocation (LDA), to perform text mining on POU-related literature. We compiled six large academic abstract datasets by searching PubMed using the Medical Subject Headings (MeSH): prescription opioid, codeine, morphine, hydrocodone, oxycodone, and methadone. We then applied topic modeling to identify topics and analyze topic similarities/differences in these six datasets. Word clouds and histograms were used to depict the distribution of vocabularies over each topic in which the most prevalent words conveyed a topic’s substance.Results The LDA topics recaptured the search keywords in PubMed, and further revealed relevant themes, such as patients, drugs, side effects, and association links between different POU and risk factors, such as gender and age. Moreover, based on the topic modeling results, TreeMap was used to fingerprint abstracts, which revealed the possibility of constructing a visualized literature index by combining topic modeling and visualization tools such as TreeMap. Meanwhile, while performing trend analysis to explore the prevalent topic dynamics in the POU-related literature, we found that an increasing trend in opioid prescription and its associated health risks are assessed as the most central issues.Conclusion The topic modeling results presented in this study not only convey an understandable and thematic structure of the POU literature, but also provide a means to discover which documents contain information about medical disorders associated with POU, thus, reducing the time and effort needed to review the literature for relevant articles. These results can be used as a preliminary study to systematically understand the risk factors related to increased POU-associated medical disorders.

scholarly journals Association Between Prescription Opioid Use and Mortality in Community-Dwelling Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 206-206
Author(s):  
Carina D’Aiuto ◽  
Helen-Maria Vasiliadis
Keyword(s):  
Older Adults ◽  
Community Dwelling ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Risk Of Death ◽  
Physical Conditions ◽  
Chronic Physical Conditions ◽  
Prescription Opioid Use ◽  
The Impact

Abstract Prescription opioid use is concerning among older adults. Yet, few studies have examined the impact of opioid use on mortality by considering multimorbidity. Our sample includes 1586 older adults aged ≥65 recruited in primary care from 2011-2013 in a large health administrative region in Quebec and participating in the ESA-Services study, a longitudinal study on aging and health service use. An opioid prescription delivered in the 3 years prior to the baseline interview was identified using the provincial pharmaceutical drug registry. Mortality was ascertained from the vital statistics registry until 2015. The presence of chronic diseases was based on self-reported and physician diagnostic codes in health administrative databases. Physical multimorbidity was defined as ≥3 chronic physical conditions from either source. Physical/psychiatric multimorbidity was defined as ≥3 chronic physical conditions and ≥1 common mental disorder from either source. Logistic regression analyses were conducted to examine the association between opioid use and mortality, controlling for sociodemographic factors. Interactions were tested for opioid use and multimorbidity. Older adults with physical multimorbidity using opioids were 1.76 (95%CI: 1.02-3.03) times more likely to die than those not using opioids. Those with physical/psychiatric multimorbidity using opioids were 2.27 (95%CI: 1.26-4.09) times more likely to die than those not using opioids. Older age, male sex, and single marital status significantly increased the risk of mortality. Overall, opioid use increases the risk of death in older adults with multimorbidity. The presence of mental disorders further increases the risk of death in older adults with physical multimorbidity using opioids.

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