Use of Drug Claims Data and a Medication Risk Score to Assess the Impact of CYP2D6 Drug Interactions among Opioid Users on Healthcare Costs

Cytochrome P450 2D6 (CYP2D6) activity is highly variable due to several factors, including genetic polymorphisms and drug-drug-gene interactions. Hydrocodone, oxycodone, codeine, and tramadol the most commonly prescribed CYP2D6-activated opioids for pain. However, the co-administration of CYP2D6 interacting drugs can modulate CYP2D6-medicated activation of these opioids, affecting drug analgesia, effectiveness, and safety, and can impact healthcare costs. A retrospective, observational cohort analysis was performed in a large (n = 50,843) adult population. This study used drug claims data to derive medication risk scores and matching propensity scores to estimate the effects of opioid use and drug-drug interactions (DDIs) on medical expenditures. 4088 individuals were identified as opioid users; 95% of those were prescribed CYP2D6-activated opioids. Among those, 15% were identified as being at risk for DDIs. Opioid users had a significant increase in yearly medical expenditure compared to non-opioid users ($2457 vs. $1210). In matched individuals, average healthcare expenditures were higher for opioid users with DDIs compared to those without DDIs ($7841 vs. $5625). The derived medication risk score was higher in CYP2D6 opioid users with interacting drug(s) compared to no DDI (15 vs. 12). Higher costs associated with CYP2D6 opioid use under DDI conditions suggest inadequate CYP2D6 opioid prescribing practices. Efforts to improve chronic opioid use in adults should reduce interacting drug combinations, especially among patients using CYP2D6 activated opioids.

Download Full-text

Identifying Predictive Characteristics of Opioid Medication Use among a Nationally Representative Sample of United States Older Adults with Pain and Comorbid Hypertension or Hypercholesterolemia

Healthcare ◽

10.3390/healthcare8030341 ◽

2020 ◽

Vol 8 (3) ◽

pp. 341

Author(s):

David R. Axon ◽

Shannon Vaffis ◽

Srujitha Marupuru

Keyword(s):

United States ◽

Older Adults ◽

Representative Sample ◽

Chronic Conditions ◽

Functional Limitation ◽

The United States ◽

Medical Expenditure ◽

Opioid Use ◽

Nationally Representative ◽

Opioid Users

The prevalence of older adults with pain and comorbid cardiovascular conditions is increasing in the United States (U.S.). This retrospective, cross-sectional database study used 2017 Medical Expenditure Panel Survey data and hierarchical logistic regression models to identify predictive characteristics of opioid use among a nationally representative sample of older U.S. adults (aged ≥50 years) with pain in the past four weeks and comorbid hypertension (pain–hypertension group) or hypercholesterolemia (pain–hypercholesterolemia group). The pain–hypertension group included 2733 subjects (n = 803 opioid users) and the pain–hypercholesterolemia group included 2796 subjects (n = 795 opioid users). In both groups, predictors of opioid use included: White race versus others, Hispanic versus non-Hispanic ethnicity, 1 versus ≥5 chronic conditions, little/moderate versus quite a bit/extreme pain, good versus fair/poor perceived mental health, functional limitation versus no functional limitation, smoker versus non-smoker, and Northeast versus West census region. In addition, Midwest versus West census region was a predictor in the pain–hypertension group, and 4 versus ≥5 chronic conditions was a predictor in the pain–hypercholesterolemia group. In conclusion, several characteristics of older U.S. adults with pain and comorbid hypertension or hypercholesterolemia were predictive of opioid use. These characteristics could be addressed to optimize individuals’ pain management and help address the opioid overdose epidemic.

Download Full-text

Addition of Rifampin to Standard Therapy for Treatment of Native Valve Infective Endocarditis Caused by Staphylococcus aureus

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00300-08 ◽

2008 ◽

Vol 52 (7) ◽

pp. 2463-2467 ◽

Cited By ~ 83

Author(s):

David J. Riedel ◽

Elizabeth Weekes ◽

Graeme N. Forrest

Keyword(s):

Staphylococcus Aureus ◽

Infective Endocarditis ◽

Drug Interactions ◽

Standard Therapy ◽

Cohort Analysis ◽

Urban Hospital ◽

Hepatitis C Infection ◽

Native Valve ◽

Duke Criteria ◽

The Impact

ABSTRACT Staphylococcus aureus is a common cause of native valve infective endocarditis (IE). Rifampin is often added to traditional therapy for the management of serious S. aureus infections. There are no large, prospective studies documenting the safety and efficacy of adjunctive therapy with rifampin for treatment of native valve S. aureus IE. We reviewed all cases of definite native valve S. aureus IE confirmed by modified Duke criteria in a large urban hospital between 1 January 2004 and 31 December 2005. A retrospective cohort analysis was used to assess the impact of the addition of rifampin to standard therapy. There were 42 cases of S. aureus IE treated with the addition of rifampin and 42 controls. Cases received a median of 20 days of rifampin (range, 14 to 48 days). Rifampin-resistant S. aureus isolates developed in nine cases who received rifampin before clearance of bacteremia (56%), while significant hepatic transaminase elevations also occurred in nine cases, all of whom had hepatitis C infection. Unrecognized significant drug-drug interactions with rifampin occurred frequently (52%). Cases were more likely to have a longer duration of bacteremia (5.2 versus 2.1 days; P < 0.001) and were less likely to survive (79% versus 95%; P = 0.048) than controls. Our results suggest that the potential for hepatotoxicity, drug-drug interactions, and the emergence of resistant S. aureus isolates warrants a careful risk-benefit assessment before adding rifampin to standard antibiotic treatment of native valve S. aureus IE until further clinical studies are performed.

Download Full-text

The impact of long-term opioid use on the risk and severity of COVID-19

Journal of Opioid Management ◽

10.5055/jom.2020.0597 ◽

2020 ◽

Vol 16 (6) ◽

pp. 401-404

Author(s):

Rahul Shah, BS ◽

Yong-Fang Kuo, PhD ◽

Jacques Baillargeon, PhD ◽

Mukaila A. Raji, MD

Keyword(s):

Prescription Opioids ◽

Immune Functions ◽

Emerging Infections ◽

Opioid Use ◽

Public Health Importance ◽

The Us ◽

Prolonged Icu Stay ◽

Opioid Users ◽

The Impact

Based on evidence of the immunosuppressive effects of chronic opioids, long-term users of prescription and illicit opioids comprise an unrecognized but growing population of Americans with compromised immune function and respiratory depression who may be at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)-related hospitalization, prolonged ICU stay, adverse events, and death. This perspective is of broad clinical and public health importance because the US has the highest population of long-term users of prescription opioids, a sequel of a decade-long practice of opioid overprescribing in the US. For long-term opioid users who are hospitalized for COVID-19, clinicians face clinical challenges arising from the suppressive effects of opioids on the respiratory and immune functions, as well as the potential for adverse drug-drug interaction when opioids have to be continued in long-term users. More research is needed to further understand the association of long-term opioid use and susceptibility to COVID-19 and other emerging infections.

Download Full-text

The Impact of Opioid Use on Human and Healthcare Costs in Surgical Patients

SSRN Electronic Journal ◽

10.2139/ssrn.3456886 ◽

2019 ◽

Author(s):

Al-Faraaz Kassam ◽

Young Kim ◽

Alexander R. Cortez ◽

Vikrom K. Dhar ◽

Koffi Wima ◽

...

Keyword(s):

Healthcare Costs ◽

Surgical Patients ◽

Opioid Use ◽

The Impact

Download Full-text

EPR19-069: Opioid Use Among Cancer Patients Undergoing Surgery and Their Associated Risk of Re-admissions and Emergency Department Visits in the 1-Year Postsurgical Period

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2018.7231 ◽

2019 ◽

Vol 17 (3.5) ◽

pp. EPR19-069 ◽

Cited By ~ 1

Author(s):

Siyana Kurteva ◽

Robyn Tamblyn ◽

Ari Meguerditchian

Keyword(s):

Emergency Department ◽

Cancer Patients ◽

Healthcare System ◽

Emergency Department Visits ◽

Administrative Claims ◽

Opioid Use ◽

Opioid Prescription ◽

Ed Visits ◽

Opioid Users ◽

The Impact

Background: Prescription opioid use and overdose has steadily increased over the past years, resulting in a dramatic increase in opioid-related emergency department (ED) visits and hospitalizations. Methods: This study used a prospective cohort of cancer patients having undergone surgery in Montreal (Quebec) to describe their post-discharge opioid use and identify potential patterns of unplanned health service use (ED visits, hospitalizations). Provincial health administrative claims were used to measure opioid dispensation as well as hospital re-admissions and ED visits. The hospital warehouse, patient chart and patient interview will be used to further describe patient’s medical profile. Marginal structural models will be used to model the association between use of opioids and risk of ED visits and hospitalizations. Inverse probability of treatment and censoring weights will be constructed to properly adjust for confounders that may be unbalanced between the opioid and non–opioid users as well as to account for competing risk due to mortality. Reasons for the re-admissions will also be presented as part of the analyses. Covariates will include patient comorbidities, medication history, and healthcare system characteristics such as nurse-to-patient and attending physician-to-patient ratios. Results (interim): A total of 821 were included in the study; of these, 73% (n=597) were admitted for a cancer procedure. At postoperative discharge, 605 (74%) of patients had at least one opioid dispensation, of which the majority (67%) were oxycodone with hydromorphone being the second most prescribed (28%). Among those who filled a prescription, mean age was 66 (13.4), 68% had no previous history of opioid use, and 10% have had 3 or more dispensing pharmacies in the year prior to admission, compared to less than 1% for the non–opioid users. Overall, 343 people refilled their opioid prescription at least once and 128 at least twice during the 1-year postoperative period. Among cancer patients who were opioid users, 214 ED visits occurred in the 1 year after surgery compared to only 40 for the non-cancer opioid users. Conclusion: This study will help to identify the risk profile of cancer patients who are most likely to continue using opioids for prolonged periods following surgical procedures as well as quantify the impact of opioid use and its associated burden on the healthcare system in order to identify areas for possible interventions.

Download Full-text

Effect of Preoperative Opioid Use on Adverse Outcomes, Medical Spending, and Persistent Opioid Use Following Elective Total Joint Arthroplasty in the United States: A Large Retrospective Cohort Study of Administrative Claims Data

Pain Medicine ◽

10.1093/pm/pnz083 ◽

2019 ◽

Vol 21 (3) ◽

pp. 521-531 ◽

Cited By ~ 20

Author(s):

Meridith Blevins Peratikos ◽

Hannah L Weeks ◽

Andrew J B Pisansky ◽

R Jason Yong ◽

Elizabeth Ann Stringer

Keyword(s):

Length Of Stay ◽

Claims Data ◽

The United States ◽

Adverse Outcomes ◽

Unplanned Readmission ◽

Administrative Claims ◽

Opioid Use ◽

Opioid Prescription ◽

Opioid Dose ◽

Opioid Users

Abstract Objective Between 17% and 40% of patients undergoing elective arthroplasty are preoperative opioid users. This US study analyzed patients in this population to illustrate the relationship between preoperative opioid use and adverse surgical outcomes. Design Retrospective study of administrative medical and pharmaceutical claims data. Subjects Adults (aged 18+) who received elective total knee, hip, or shoulder replacement in 2014–2015. Methods A patient was a preoperative opioid user if opioid prescription fills occurred in two periods: 1–30 and 31–90 days presurgery. Zero-truncated Poisson (incidence rate ratio [IRR]), logistic (odds ratio [OR]), Cox (hazard ratio [HR]), and quantile regressions modeled the effects of preoperative opioid use and opioid dose, adjusted for demographics, comorbidities, and utilization. Results Among 34,792 patients (38% hip, 58% knee, 4% shoulder), 6,043 (17.4%) were preoperative opioid users with a median morphine equivalent daily dose of 32 mg. Preoperative opioid users had increased length of stay (IRR = 1.03, 95% CI = 1.02 to 1.05), nonhome discharge (OR = 1.10, 95% CI = 1.00 to 1.21), and 30-day unplanned readmission (OR = 1.43, 95% CI = 1.17 to 1.74); experienced 35% higher surgical site infection (HR = 1.35, 95% CI = 1.14 to 1.59) and 44% higher surgical revision (HR = 1.44, 95% CI = 1.21 to 1.71); had a median $1,084 (95% CI = $833 to $1334) increase in medical spend during the 365 days after discharge; and had a 64% lower rate of opioid cessation (HR = 0.34, 95% CI = 0.33 to 0.35) compared with patients not filling two or more prescriptions across periods. Conclusions Preoperative opioid users had longer length of stay, increased revision rates, higher spend, and persistent opioid use, which worsened with dose. Adverse outcomes after elective joint replacement may be reduced if preoperative opioid risk is managed through increased monitoring or opioid cessation.

Download Full-text

Medical expenditure after marginal cut of cash benefit among public assistance recipients in Japan: natural experimental evidence

Journal of Epidemiology & Community Health ◽

10.1136/jech-2021-217296 ◽

2021 ◽

pp. jech-2021-217296

Author(s):

Daisuke Nishioka ◽

Reo Takaku ◽

Naoki Kondo

Keyword(s):

Child Support ◽

Healthcare Costs ◽

Public Assistance ◽

Behavioural Change ◽

Medical Expenditure ◽

Outpatient Visits ◽

Poor Households ◽

Study Population ◽

The Impact ◽

Firstborn Child

BackgroundsIncome reduction in poor households affects healthcare demands for impoverished population. However, the impact of reduced benefits for public assistance recipients, who can use medical services for free, on healthcare costs has not been examined. We hypothesised that marginal cuts in benefits increase recipients’ medical expenditure by extra demand for medical care. We tested this hypothesis using public assistance databases of Japan.MethodsThe study population comprised households in five municipalities receiving public assistance between April 2016 and September 2018. The households have a child aged 12–60 months and receive a monthly child-support income of US$150, which reduces by US$50 when the child turns 36 months of age. Our analysis comprised an age-based sharp regression-discontinuity study.ResultsWe observed 4893 household-months (11 032 person-months). When a firstborn child reached 36 months, their frequency of outpatient visits and healthcare costs by recipients, except for the firstborn child, increased (0.45, 95% CI: 0.30 to 0.61; US$111.2, 95% CI: 20.7 to 201.7), while those of the firstborn child did not increase significantly. The monthly medical expenditure per household increased by US$248.6 (95% CI: 25.4 to 471.7). Inpatient medical costs increased significantly (US$64.3, 95% CI: 8.4 to 120.2).ConclusionsGovernment savings through income reduction were offset by increased medical expenditure. This may be due to recipients’ behavioural change and their worsening health conditions. To prevent excessive medical expenditure, policymakers should consider how income reduction affects the behaviour and health of the impoverished population.

Download Full-text

The Impact of Obesity on Medical Care Costs and Labor Market Outcomes in the US

Clinical Chemistry ◽

10.1373/clinchem.2017.272450 ◽

2018 ◽

Vol 64 (1) ◽

pp. 108-117 ◽

Cited By ~ 37

Author(s):

Adam Biener ◽

John Cawley ◽

Chad Meyerhoefer

Keyword(s):

Medical Care ◽

Healthcare Costs ◽

Previous Literature ◽

Medical Expenditures ◽

Economic Outcomes ◽

Medical Expenditure ◽

Medical Care Costs ◽

The Us ◽

The Impact ◽

Care Costs

Abstract BACKGROUND The prevalence of obesity has risen dramatically in most countries of the world, and the economic consequences of obesity are not well understood. METHODS We analyzed data from the Medical Expenditure Panel Survey (MEPS) for 2001–2015 and estimated the percentage of healthcare costs that were associated with adult obesity, both for the US as a whole and for the most populous states. We also reviewed the literature on the impact of obesity on economic outcomes such as medical care costs, employment, and wages. RESULTS The percent of US national medical expenditures devoted to treating obesity-related illness in adults rose from 6.13% in 2001 to 7.91% in 2015, an increase of 29%. Substantial differences existed across states; in 2015, some states (AZ, CA, FL, NY) devoted 5%–6% of medical expenditures to obesity, whereas others (NC, OH, WI) spent >12% of all healthcare dollars on obesity. A review of previous literature that exploited natural experiments to estimate causal effects found that obesity raises medical care costs and lowers wages and the probability of employment. CONCLUSIONS A substantial and rising percentage of healthcare costs are associated with obesity. This is true for the US, for individual states, for each category of expenditure, and for each type of payer. Previous literature generally found that obesity worsens economic outcomes, such as medical care costs, wages, and employment, and imposes negative external costs that may justify government intervention.

Download Full-text

Opioid users show worse baseline knee osteoarthritis and faster progression of degenerative changes: a retrospective case-control study based on data from the Osteoarthritis Initiative (OAI)

Arthritis Research & Therapy ◽

10.1186/s13075-021-02524-9 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Jannis Bodden ◽

Gabby B. Joseph ◽

Silvia Schirò ◽

John A. Lynch ◽

Nancy E. Lane ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Structural Changes ◽

Linear Regression Models ◽

Opioid Use ◽

Retrospective Case ◽

Osteoarthritis Initiative ◽

Opioid Users ◽

The Impact

Abstract Background Opioids are frequently prescribed for pain control in knee osteoarthritis patients, despite recommendations by current guidelines. Previous studies have investigated the chondrotoxicity of different opioid subtypes. However, the impact opioids may have on progression of osteoarthritis in vivo remains unknown. The aim of this study was thus to describe the associations between opioid use and knee structural changes and clinical outcomes, over 4 years. Methods Participants with baseline opioid use (n=181) and who continued use for ≥1 year between baseline and 4-year follow-up (n=79) were included from the Osteoarthritis Initiative cohort and frequency matched with non-users (controls) (1:2). Whole-Organ Magnetic Resonance Imaging Scores (WORMS) were obtained, including a total summation score (WORMS total, range 0–96) and subscores for cartilage (0–36), menisci (0–24), and bone marrow abnormalities and subchondral cyst-like lesions (0–18, respectively). Knee Injury Osteoarthritis Outcomes score (KOOS) symptoms, quality of life (QOL), and pain were also obtained at baseline and follow-up (range 0–100; lower scores indicate worse outcomes). Using linear regression models, associations between baseline and longitudinal findings were investigated. As pain may modify observations, a sensitivity analysis was performed for longitudinal findings. All analyses were adjusted for sex, BMI, age, race, and Kellgren-Lawrence grade. Results Opioid users had greater structural degeneration at baseline (WORMS total: Coef. [95% CI], P; 7.1 [5.5, 8.8], <0.001) and a greater increase over 4 years (4.7 [2.9, 6.5], <0.001), compared to controls. Cartilage and meniscus scores increased greater in opioid users, compared to controls (P≤0.001), and findings withstood the adjustment for baseline pain (P≤0.002). All baseline KOOS scores were lower in opioid users compared to controls (P<0.001). QOL loss was greater, when adjusted for baseline KOOS pain (QOL −6.9 [−11.6, −2.1], 0.005). Conclusions Opioid users had worse baseline knee structural degeneration and faster progression. Opioid use was also associated with worse symptoms, pain, and QOL. Furthermore, QOL loss was greater in opioid users compared to controls, when adjusted for baseline KOOS pain, indicating that opioids may not be suited to prevent subjective disease progression in KOA patients.

Download Full-text

Key characteristics and habits of the recreational opioid user

Journal of Opioid Management ◽

10.5055/jom.2019.0542 ◽

2019 ◽

Vol 15 (6) ◽

pp. 507-520

Author(s):

Anna Schinas, MSc ◽

Shein Nanji, BSc ◽

Kira Vorobej, MSc ◽

Catherine Mills, MSc ◽

Dawn Govier, BSc ◽

...

Keyword(s):

Drug Abuse ◽

Drug Use ◽

Smoking Status ◽

Demographic Data ◽

Recreational Drug ◽

Opioid Use ◽

Key Characteristics ◽

Recreational Drug Use ◽

Opioid Users ◽

The Impact

Objective: To identify key characteristics and habits of recreational opioid users.Design: The data were compiled from volunteers who participated in clinical studies at a contract research organization in Toronto, Ontario, Canada.Interventions: Data were collected from 5,018 male and female recreational opioid users via telephone and face-to-face screening interviews. Five recreational opioid users participated in a live interview broadcast on the internet.Main outcome measures: Demographic data, recreational drug use history, routes of recreational drug administration, alcohol use, and smoking status. A subset of the demographic information and recreational drug use history was summarized separately using data collected between 2013 and 2016 from 114 recreational opioid users who were not dependent on opioids. Interview excerpts were included from five recreational opioid users who described their real-world experiences with drug abuse, including the impact of abuse-deterrent opioid formulations on their drug abuse behavior.Results: The preferred route of administration of opioids was oral (52 percent), followed by intranasal (36 percent), intravenous (10 percent), and buccal (chewing on a patch; 2 percent). Other substances used included nicotine, alcohol, and non-opioid psychoactive drugs (primarily cannabis). Oxycodone was the most frequently reported opioid of abuse.Conclusions: Recreational opioid users have distinct drug-related behaviors and preferences. Monitoring current trends and examining these behaviors is an important component to understand the potential safety risks associated with recreational opioid use.

Download Full-text