Factors Associated with Prescription Opioid Analgesic Use in the US Population, 2011–2014

Abstract Objective This study examined factors associated with prescription opioid analgesic use in the US population using data from a nationally representative sample. It focused on factors previously shown to be associated with opioid use disorder or overdose. Variations in the use of different strength opioid analgesics by demographic subgroup were also examined. Methods Data came from respondents aged 16 years and older who participated in the National Health and Nutrition Examination Survey (2011–2014). Respondents were classified as opioid users if they reported using one or more prescription opioid analgesics in the past 30 days. Results Opioid users reported poorer self-perceived health than those not currently using opioids. Compared with those not using opioids, opioid users were more likely to rate their health as being “fair” or “poor” (40.4% [95% confidence interval {CI} = 34.9%–46.2%] compared with 15.6% [95% CI = 14.3%–17.1%]), experienced more days of pain during the past 30 days (mean = 14.3 [95% CI = 12.9–15.8] days compared with 2.3 [95% CI = 2.0–2.7] days), and had depression (22.5% [95% CI = 17.3%–28.7%] compared with 7.1% [95% CI = 6.2%–8.0%]). Among those who reported using opioids during the past 30 days, 18.8% (95% CI = 14.4%–24.1%) reported using benzodiazepine medication during the same period and 5.2% (95% CI = 3.5%–7.7%) reported using an illicit drug during the past six months. When opioid strength was examined, a smaller percentage of adults aged 60 years and older used stronger-than-morphine opioids compared with adults aged 20–39 and 40–59 years. Conclusions Higher percentages of current opioid users than nonusers reported having many of the factors associated with opioid use disorder and overdose.

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Dynamic Changes in Prescription Opioids from 2006 to 2017 in Texas

10.1101/19004879 ◽

2019 ◽

Author(s):

Ebuwa T Ighodaro ◽

Kenneth L McCall ◽

Daniel Y Chung ◽

Stephanie D Nichols ◽

Brian J Piper

Keyword(s):

Rural Areas ◽

Opioid Analgesics ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Prescription Opioids ◽

Opioid Use ◽

Study Objective ◽

The Us ◽

Urban And Rural Areas ◽

Opioid Diversion

AbstractStudy ObjectiveThe US is experiencing an epidemic of opioid overdoses which may be at least partially due to an over-reliance on opioid analgesics in the treatment of chronic non-cancer pain and subsequent escalation to heroin or illicit fentanyl. As Texas was reported to be among the lowest in the US for opioid use and misuse, further examination of this state is warranted.Study DesignThis study was conducted to quantify prescription opioid use in Texas.Data SourceData was obtained from the publically available US Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) which monitors controlled substances transactions from manufacture to commercial distribution.Measurement and Main ResultsData for 2006-2017 from Texas for ten prescription opioids including eight primarily used to relieve pain (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine, oxycodone, oxymorphone) and two (buprenorphine and methadone) for the treatment of an Opioid Use Disorder (OUD) were examined. The change in Morphine Mg Equivalent (MME) of all opioids (+23.3%) was only slightly greater than the state’s population gains (21.1%). Opioids used to treat an OUD showed pronounced gains (+90.8%) which were four-fold faster than population growth. Analysis of individual agents revealed pronounced elevations in codeine (+387.5%), hydromorphone (+106.7%), and oxycodone (+43.6%) and a reduction in meperidine (−80.3%) in 2017 relative to 2006. Methadone in 2017 accounted for a greater portion (39.5%) of the total MME than hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, and meperidine, combined. There were differences between urban and rural areas in the changes in hydrocodone and buprenorphine.ConclusionsCollectively, these findings indicate that continued vigilance is needed in Texas to appropriately treat pain and an OUD while minimizing the potential for prescription opioid diversion and misuse. Texas may lead the US in a return to pre opioid crisis prescription levels.

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Dynamic changes in prescription opioids from 2006 to 2017 in Texas

PeerJ ◽

10.7717/peerj.8108 ◽

2019 ◽

Vol 7 ◽

pp. e8108 ◽

Cited By ~ 3

Author(s):

Ebuwa O. Ighodaro ◽

Kenneth L. McCall ◽

Daniel Y. Chung ◽

Stephanie D. Nichols ◽

Brian J. Piper

Keyword(s):

Rural Areas ◽

Opioid Analgesics ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Distribution Data ◽

Prescription Opioids ◽

Opioid Use ◽

The Us ◽

Urban And Rural Areas ◽

Opioid Diversion

Background The US is experiencing an epidemic of opioid overdoses which may be at least partially due to an over-reliance on opioid analgesics in the treatment of chronic non-cancer pain and subsequent escalation to heroin or illicit fentanyl. As Texas was reported to be among the lowest in the US for opioid use and misuse, further examination of this state is warranted. Materials and Methods This study was conducted to quantify prescription opioid use in Texas. Data was obtained from the publicly available US Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) which monitors controlled substances transactions from manufacture to commercial distribution. Data for 2006–2017 from Texas for ten prescription opioids including eight primarily used to relieve pain (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine, oxycodone, oxymorphone) and two (buprenorphine and methadone) for the treatment of an Opioid Use Disorder (OUD) were examined. Results The change in morphine mg equivalent (MME) of all opioids (+23.3%) was only slightly greater than the state’s population gains (21.1%). Opioids used to treat an OUD showed pronounced gains (+90.8%) which were four-fold faster than population growth. Analysis of individual agents revealed pronounced elevations in codeine (+387.5%), hydromorphone (+106.7%), and oxycodone (+43.6%) and a reduction in meperidine (−80.3%) in 2017 relative to 2006. Methadone in 2017 accounted for a greater portion (39.5%) of the total MME than hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, and meperidine, combined. There were differences between urban and rural areas in the changes in hydrocodone and buprenorphine. Conclusions Collectively, these findings indicate that continued vigilance is needed in Texas to appropriately treat pain and an OUD while minimizing the potential for prescription opioid diversion and misuse. Texas may lead the US in a return to pre-opioid epidemic prescription levels.

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Prescription Opioid Analgesic Use and Mortality in Systemic Lupus Erythematosus

10.1101/395343 ◽

2018 ◽

Cited By ~ 1

Author(s):

Romy J. Cabacungan ◽

Clifford R. Qualls ◽

Wilmer L Sibbitt ◽

William A. Hayward ◽

James I. Gibb ◽

...

Keyword(s):

Lupus Erythematosus ◽

Opioid Analgesic ◽

Opioid Analgesics ◽

Hazard Ratio ◽

Prescription Opioid ◽

Opioid Use ◽

Systemic Lupus ◽

Probability Of Death ◽

Prescription Opioid Use ◽

Analgesic Use

AbstractObjectivesThis research investigated the prevalence of opioid analgesic use in patients with systemic lupus erythematosus (SLE).MethodsThis 5-year prospective cohort study of 275 SLE patients focused on prescription opioid use and 5-year outcome. Associations were determined with univariable regression analysis and then multivariable models were created to determine independent effects on dependent variablesResultsPrescription opioid use was common in SLE with 24% using opioid analgesics chronically and 76% not using opioids. Opioid users had a higher rate of tobacco use (p<0.01), cocaine use (p<0.002), mean pain scores (p<0.001), disease activity (SLEDAI-2K) (p<0.001), disease damage (SLICC/ACRDI) (p<0.001), non-adherence to medical therapy (p<0.01), and total deaths at 5 years (opioids: 48.0%, no opioids 19.0%, p<0.001). Logistic regression analysis predicting death revealed opioid use (hazard ratio 2.6, p<0.001) and SLEDAI-2K (1.1, p<0.001) respectively; and opioid use (hazard ratio 2.5, p<0.002), SLEDAI-2K (hazard ratio 1.1, p<0.001), and non-adherence (hazard ratio 1.6, p=0.11), respectively. Multivariable Cox Model analysis estimating probability of death with covariates: opioid use (hazard ratio 2.6, p<0.001) and SLEDAI-2K (hazard ratio 1.1, p<0.001); opioid use (hazard ratios 3.0, p<0.001), and cocaine use (hazard ratio 3.2, p<0.001). The Kaplan-Meir survival analysis revealed a significantly higher probability of death for SLE patients using opioid analgesics.ConclusionsPrescription opioid analgesic use is common in SLE and is associated with markedly increased mortality. Preferably, non-opioid approaches to treat chronic pain should be used in SLE patients.Clinical trial registration numberThis was not a clinical trial.KEY MESSAGES:1. Chronic opioid analgesic use is common in SLE (24%).2. Opioid use is associated with greater disease severity, tobacco use, non-adherence, and increased mortality.3. Opioids should be used cautiously in SLE; alternative non-opioid management of pain is recommended.ACKNOWLEDGMENTS AND FUNDING INFORMATION:This work was supported by US National Institutes of Health research grants to Dr. Sibbitt (R01 NS035708) and to the Clinical and Translational Research Center (UL1TR001449).

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Demographic characteristics, medical and psychiatric history of patients with prescription opioid use disorder

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1025 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S300-S301

Author(s):

S. Herrera ◽

A. Riquelme ◽

T. León ◽

M. Babul

Keyword(s):

Opioid Analgesics ◽

The United States ◽

Opioid Use Disorder ◽

Demographic Characteristics ◽

Prescription Opioid ◽

Psychiatric History ◽

Opioid Use ◽

History Of ◽

Competing Interest ◽

Prescription Opioid Misuse

IntroductionOver the past two decades the prescription of opioid analgesics has increased with a subsequent escalating in prescription opioid misuse. It is estimated that 4.5 million (2.5%) of the United States of America population abuse of pain relievers; opioids are among the most commonly.In Chile there are few reports about the prevalence of opioid use disorder.ObjectivesThe aim of this study is to describe the demographic characteristics, medical and psychiatric comorbidity of patients that suffer from opioid addiction.Patients and methodsThis transversal study examined data of 7 patients with opioid use disorder (OUD; DSM-5) that consulted at the addiction unit of “Red de Salud, Pontificia Universidad Católica de Chile”, between November 2013 and October 2015. Data included: demographics, medical and psychiatric history, laboratory and imaging tests.ResultsOf all the patients, 57% were men, 25 to 67 years of age, 43% between 35-40 years; 57% were married; 57% had completed studies at university. 43% had also alcohol use disorder, 28% marijuana, 28% cocaine and 28% benzodiazepines than in most cases began before OUD. In addition; 57% had medical comorbidity among which stand out obesity (17%), osteoarthritis (17%) and chronic low back pain (17%). Eighty-three percent require hospitalization. Twenty-eight percent had abnormal liver tests and one patient had positive hepatitis B core antibody. Opioids used were: morphine(14%), codeine (43%), tramadol (42%).ConclusionThese results emphasize on the misuse of prescription opioids analgesics, the complexity of patients with OUD and the prevalence of other substance use disorder that precedes and accompany OUD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Treatment Persistence Among Insured Patients Newly Starting Buprenorphine/Naloxone for Opioid Use Disorder

Annals of Pharmacotherapy ◽

10.1177/1060028017751913 ◽

2018 ◽

Vol 52 (5) ◽

pp. 405-414 ◽

Cited By ~ 11

Author(s):

Natalia Shcherbakova ◽

Gary Tereso ◽

Jacqueline Spain ◽

Robert J. Roose

Keyword(s):

Health Care ◽

Health Care Providers ◽

Care Delivery ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Care Providers ◽

Opioid Use ◽

Treatment Persistence ◽

Factors Associated ◽

Insured Patients

Background: Persistence with medication-assisted therapy among patients with opioid use disorder has been associated with reduced likelihood of illicit opioid use. Objective: We aimed to describe treatment persistence and identify factors associated with 1-year persistence among insured patients newly initiating buprenorphine-containing pharmacotherapy. Methods: The retrospective observational cohort included employer-sponsored and managed Medicaid patients newly started on buprenorphine-containing therapy between June 30, 2010, and January 1, 2015. Persistence was measured as both a continuous and dichotomous variable (proportion of patients persistent for 1 year). Multivariable logistic regression analysis was used to identify factors associated with 1-year persistence. Results: A total of 302 patients met inclusion criteria. The median [range] number of treatment episodes was 1 [1-4]. Mean number of days on therapy during the first episode was 206 (SD = 152) days, with 40.4% (n = 122) of patients persisting for 1 year. Presence of concomitant fills of prescription opioid analgesics (odds ratio [OR] = 0.25; 95% CI = 0.12-0.51), being in care of an addiction specialist (OR = 0.40; 95% CI = 0.21-0.76), and Medicaid insurance coverage (OR = 0.33; 95% CI = 0.13-0.84) were significantly and negatively associated with 1-year persistence. There was also a strong inverse relationship between persistence and inpatient hospitalization (OR = 0.30; 95% CI = 0.12-0.76). Conclusions: Several health care delivery and use variables were significantly associated with nonpersistence. Concomitant use of prescription opioids is the most easily modifiable risk factor that health care providers and policy makers may act on to improve treatment continuation.

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Exploring the latent trait of opioid use disorder criteria among frequent nonmedical prescription opioid users

Journal of Psychiatric Research ◽

10.1016/j.jpsychires.2016.05.007 ◽

2016 ◽

Vol 80 ◽

pp. 79-86 ◽

Cited By ~ 5

Author(s):

João Mauricio Castaldelli-Maia ◽

Laura H. Andrade ◽

Katherine M. Keyes ◽

Magdalena Cerdá ◽

Daniel J. Pilowsky ◽

...

Keyword(s):

Latent Trait ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Opioid Use ◽

Opioid Users

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Hydromorphone use for acute pain: Misconceptions, controversies, and risks

Journal of Opioid Management ◽

10.5055/jom.2018.0430 ◽

2018 ◽

Vol 14 (1) ◽

pp. 61 ◽

Cited By ~ 3

Author(s):

Maryann Mazer-Amirshahi, PharmD, MD, MPH ◽

Sergey Motov, MD ◽

Lewis S. Nelson, MD

Keyword(s):

Acute Pain ◽

Adverse Drug Events ◽

Opioid Analgesic ◽

Opioid Analgesics ◽

Abuse Liability ◽

Prescription Opioid ◽

Potential Contribution ◽

Limited Data ◽

Opioid Use ◽

Chronic Opioid Use

Hydromorphone (HM) is a potent opioid analgesic that is commonly administered in the emergency department (ED) and other acute care settings, such as medical surgical wards. In recent years, there has been a significant increase in the ED administration of HM relative to other opioids. Although HM is an effective analgesic, its use has been commonly implicated in adverse drug events and medication errors. In addition, intravenous HM has potent euphoric effects that may contribute to its abuse liability. There are limited data regarding how acute parenteral administration of opioid analgesics in the setting of high rates of preexisting chronic opioid use (medical or nonmedical) may contribute to or reinforce addictive behavior, making the potential contribution of rising HM administration to subsequent prescription opioid abuse and overdose uncertain. This review addresses the pharmacology of HM, recommended dosing, its efficacy for acute pain, as well as its tolerability, safety, and abuse profiles. Controversies and strategies for appropriate use of this medication are also described.

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Clinical and demographic covariates of chronic opioid and non-opioid analgesic use in rural-dwelling older adults: the MoVIES project

International Psychogeriatrics ◽

10.1017/s104161021300121x ◽

2013 ◽

Vol 25 (11) ◽

pp. 1801-1810 ◽

Cited By ~ 5

Author(s):

Jordan F. Karp ◽

Ching-Wen Lee ◽

Jonathan McGovern ◽

Gary Stoehr ◽

Chung-Chou H. Chang ◽

...

Keyword(s):

Sleep Problems ◽

Opioid Analgesic ◽

Secondary Analysis ◽

Opioid Analgesics ◽

Epidemiological Data ◽

Population Based ◽

Opioid Use ◽

Original Cohort ◽

Analgesic Use ◽

Chronic Use

ABSTRACTBackground:To describe covariates and patterns of late-life analgesic use in the rural, population-based MoVIES cohort from 1989 to 2002.Methods:Secondary analysis of epidemiologic survey of elderly people conducted over six biennial assessment waves. Potential covariates of analgesic use included age, gender, depression, sleep, arthritis, smoking, alcohol, and general health status. Of the original cohort of 1,681, this sample comprised 1,109 individuals with complete data on all assessments. Using trajectory analysis, participants were characterized as chronic or non-chronic users of opioid and non-opioid analgesics. Multivariable regression was used to model predictors of chronic analgesic use.Results:The cohort was followed for mean (SD) 7.3 (2.7) years. Chronic use of opioid analgesics was reported by 7.2%, while non-opioid use was reported by 46.1%. In the multivariable model, predictors of chronic use of both opioid and non-opioid analgesics included female sex, taking ≥2 prescription medications, and “arthritis” diagnoses. Chronic opioid use was also associated with age 75–84 years; chronic non-opioid use was also associated with sleep continuity disturbance.Conclusions:These epidemiological data confirm clinical observations and generate hypotheses for further testing. Future studies should investigate whether addressing sleep problems might lead to decreased use of non-opioid analgesics and possibly enhanced pain management.

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Trends in Urine Drug Monitoring Among Persons Receiving Long-Term Opioids and Persons with Opioid Use Disorder in the United States

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.e249-e256 ◽

2021 ◽

pp. E249-E256

Keyword(s):

Chronic Pain ◽

Drug Monitoring ◽

Opioid Analgesics ◽

The United States ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Administrative Claims ◽

Opioid Use ◽

Urine Drug ◽

Prescription Opioid Analgesics

BACKGROUND: Practice guidelines recommend urine drug monitoring (UDM) at least annually in the setting of chronic opioid therapy as an objective assessment of substance use. However, empirical evidence on who gets tested and how often testing occurs is lacking. OBJECTIVES: This study investigates 10-year UDM trends in the United States based on 2 factors: (1) the duration of prescription opioid treatment, and (2) having an opioid use disorder (OUD) diagnosis and medications for opioid use disorder (MOUD) prescriptions. STUDY DESIGN: Observational cross-sectional study. SETTING: Research was conducted using administrative claims data from Optum’s deidentified Clinformatics Data Mart Database for the period 2007 to 2016. The dataset contained information on the plan enrollment and health care claims from 50 states and the District of Columbia. METHODS: To examine trends in UDM based on the duration of prescription opioid treatment, persons receiving prescription opioid analgesics were categorized into 4 groups based on the number of days covered: (a) less than 90 days, (b) 90 to 179 days, (c) 180 to 269 days, and (d) at least 270 days. To examine trends based on an OUD diagnosis and MOUD prescriptions, persons diagnosed with OUD were identified and categorized based on the presence of MOUD prescriptions as follows: (a) OUD with buprenorphine (BPN) and naltrexone (NTX) in the same year; (b) OUD with BPN only; (c) OUD with NTX only; (d) OUD with chronic prescription opioid analgesics (≥ 90 days); (e) OUD without prescription opioid analgesics, BPN, or NTX; and (f) chronic prescription opioid analgesics (≥ 90 days) without an OUD diagnosis. For analysis, the percent receiving UDM was estimated per group per year. Then the data were restricted to those receiving at least one UDM to estimate the average number of UDM per person. RESULTS: Data included an average of 364,485 persons per year receiving prescription opioid analgesics for chronic use, and 10,277 per year receiving an OUD diagnosis. Among those receiving prescription opioid analgesics, less than 50% received UDM. For those receiving at least one UDM, one additional UDM was performed per person as the duration of opioids increased by 90 days. Among persons with OUD, the percent receiving UDM was the highest for those receiving both BPN and NTX (87%), followed by those receiving BPN only (80%), chronic opioids (79%), NTX only (72%), and those not receiving any MOUD/opioids (54%). LIMITATIONS: Methadone dispensing for OUD treatments was not captured in administrative claims data. CONCLUSIONS: Although recommended for patients with chronic pain, UDM is provided less than half of the time for these patients. However, once patients received at least one UDM, they would continue to receive it on a fairly regular basis. Compared with those with chronic pain, persons diagnosed with OUD are more likely to receive UDM at a more frequent interval. KEY WORDS: Urine drug monitoring, urine drug testing, urine drug screening, chronic pain, opioid use disorder, prescription opioid analgesic, buprenorphine, naltrexone, medications for opioid use disorder

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