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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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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Tapentadol is the least common opioid found in admission urine drug-test results at an intensive outpatient opioid-use disorder treatment program in Ohio: A brief report

Journal of Opioid Management ◽

10.5055/jom.2021.0610 ◽

2021 ◽

Vol 17 (1) ◽

pp. 13-17

Author(s):

Adam Rzetelny, PhD ◽

Diana Meske, PhD ◽

Parag Patel, MD, FACOG, FASAM ◽

Steven Passik, PhD

Keyword(s):

Treatment Program ◽

Opioid Use Disorder ◽

Common Finding ◽

Prescription Opioid ◽

Test Results ◽

Opioid Use ◽

Drug Test ◽

Urine Drug ◽

Urine Drug Test ◽

Dispensing Data

Background: Previous data suggest that tapentadol, an atypical opioid with a putative dual mechanism of action, has relatively low rates of abuse. A better understanding of the rates of abuse among different prescription opioids may help clinicians when considering their potential risks and benefits. The results of urine drug tests (UDTs) may provide a unique opportunity to help answer this question.Method: To investigate different rates of prescription-opioid abuse in this retrospective study, we examined urine drug test results from patients seeking treatment at four facilities of an opioid-use-disorder (OUD) treatment program in Ohio. Urine specimens were collected on admission, one from each patient, in the regular course of care. The opioids reviewed in the present study were tapentadol, hydrocodone, oxycodone, hydromorphone, oxymorphone, and tramadol. Drug dispensing data, including morphine-milligram equivalents (MME) dispensed, were examined to adjust for the relative prevalence of each opioid being examined.Results: Data from 4,162 patients were examined. Tapentadol was the least common finding in UDT results in this cohort and remained so after adjusting for drug availability. The percentage of specimens positive for a given opioid ranged from 0.12 percent (tapentadol) to 7.04 percent (oxycodone). The availability and MME adjustments resulted in a change of rank order, with tapentadol remaining the lowest but tramadol replacing oxycodone as the prescription opioid with the highest rate of abuse.Conclusions: In this sample of UDT results from patients seeking treatment at an OUD program in Ohio, tapentadol was the least frequent finding among the opioids examined, and this remained true when adjusting for dispensing data. Factors potentially contributing to this difference may include pharmacological properties unique to tapentadol. Several important limitations notwithstanding, these findings are consistent with previous real-world evidence and warrant an ongoing line of inquiry.

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Patterns of Long-Term Prescription Opioid Use Among Older Adults in the United States: A Study of Medicare Administrative Claims Data

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.31-40 ◽

2020 ◽

Vol 1;24 (1;1) ◽

pp. 31-40

Keyword(s):

Older Adults ◽

Claims Data ◽

The United States ◽

Prescription Opioid ◽

Administrative Claims ◽

Medicare Beneficiaries ◽

Opioid Use ◽

Opioid Prescription ◽

Administrative Claims Data

BACKGROUND: Long-term opioid therapy was prescribed with increasing frequency over the past decade. However, factors surrounding long-term use of opioids in older adults remains poorly understood, probably because older people are not at the center stage of the national opioid crisis. OBJECTIVES: To estimate the annual utilization and trends in long-term opioid use among older adults in the United States. STUDY DESIGN: Retrospective cohort study. SETTING: Data from Medicare-enrolled older adults. METHODS: This study utilized a nationally representative sample of Medicare administrative claims data from the years 2012 to 2016 containing records of health care services for more than 2.3 million Medicare beneficiaries each year. Medicare beneficiaries who were 65 years of age or older and who were enrolled in Medicare Parts A, B, and D, but not Part C, for at least 10 months in a year were included in the study. We measured annual utilization and trends in new long-term opioid use episodes over 4 years (2013–2016). We examined claims records for the demographic characteristics of the eligible individuals and for the presence of chronic non-cancer pain (CNCP), cancer, and other comorbidities. RESULTS: From 2013 to 2016, administrative claims of approximately 2.3 million elderly Medicare beneficiaries were analyzed in each year with a majority of them being women (~56%) and white (~82%) with a mean age of approximately 75 years. The proportion of all eligible beneficiaries with at least one new opioid prescription increased from 6.64% in 2013, peaked at 10.32% in 2015, and then decreased to 8.14% in 2016. The proportion of individuals with long-term opioid use among those with a new opioid prescription was 12.40% in 2013 and 10.20% in 2016. Among new long-term opioid users, the proportion of beneficiaries with a cancer diagnosis during the study years increased from 13.30% in 2013 to 15.67% in 2016, and the proportion with CNCP decreased from 30.25% in 2013 to 27.36% in 2016. Across all years, long-term opioid use was consistently high in the Southern states followed by the Midwest region. LIMITATIONS: This study used Medicare fee-for-service administrative claims data to capture prescription fill patterns, which do not allow for the capture of individuals enrolled in Medicare Advantage plans, cash prescriptions, or for the evaluation of appropriateness of prescribing, or the actual use of medication. This study only examined long-term use episodes among patients who were defined as opioid-naive. Finally, estimates captured for 2016 could only utilize data from 9 months of the year to capture 90-day long-term-use episodes. CONCLUSIONS: Using a national sample of elderly Medicare beneficiaries, we observed that from 2013 to 2016 the use of new prescription opioids increased from 2013 to 2014 and peaked in 2015. The use of new long-term prescription opioids peaked in 2014 and started to decrease from 2015 and 2016. Future research needs to evaluate the impact of the changes in new and long-term prescription opioid use on population health outcomes. KEY WORDS: Long-term, opioids, older adults, trends, Medicare, chronic non-cancer pain, cancer, cohort study

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The Opioid Crisis

Encyclopedia of Social Work ◽

10.1093/acrefore/9780199975839.013.1350 ◽

2020 ◽

Author(s):

M. Aryana Bryan ◽

Valerie Hruschak ◽

Cory Dennis ◽

Daniel Rosen ◽

Gerald Cochran

Keyword(s):

United States ◽

Social Work ◽

Management Practices ◽

Critical Role ◽

Work Practice ◽

The United States ◽

Social Work Practice ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Opioid Use

Opioid-related deaths by overdoses quadrupled in the United States from the years 1999 to 2015. This rise in mortality predominately occurred in the wake of historic changes in pain management practices and aggressive marketing of opioid medications such as oxycontin. Prescription opioid misuse and subsequent addiction spilled over to heroin and fentanyl for many. This drug epidemic differed from others in its impact among non-Hispanic whites, leading to drastic changes in how the United States views addiction and chooses to respond. This article offers an overview of opioid use disorder (OUD), its treatment and its relationship with pain. It also discusses special populations affected and provides insight into future directions for research and social work practice surrounding opioid management in the United States. Because of the profession’s emphasis on the person and social environment as well as its focus on vulnerable and oppressed populations, social work plays a critical role in addressing the crisis.

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Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States

American Journal of Psychiatry ◽

10.1176/appi.ajp.2017.17040413 ◽

2018 ◽

Vol 175 (1) ◽

pp. 47-53 ◽

Cited By ~ 76

Author(s):

Mark Olfson ◽

Melanie M. Wall ◽

Shang-Min Liu ◽

Carlos Blanco

Keyword(s):

United States ◽

The United States ◽

Opioid Use Disorder ◽

Cannabis Use ◽

Prescription Opioid ◽

Opioid Use ◽

Prescription Opioid Use

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

Pain Medicine ◽

10.1093/pm/pny158 ◽

2018 ◽

Vol 20 (7) ◽

pp. 1338-1346 ◽

Cited By ~ 3

Author(s):

Steven M Frenk ◽

Susan L Lukacs ◽

Qiuping Gu

Keyword(s):

Opioid Analgesic ◽

Opioid Analgesics ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Opioid Use ◽

Factors Associated ◽

The Past ◽

The Us ◽

Opioid Users ◽

Analgesic Use

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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Kratom Use Within the Context of the Evolving Opioid Crisis and the COVID-19 Pandemic in the United States

Frontiers in Pharmacology ◽

10.3389/fphar.2021.729220 ◽

2021 ◽

Vol 12 ◽

Author(s):

Walter C. Prozialeck ◽

Peter C. Lamar ◽

Michael Krupp ◽

Matthew Moon ◽

Laura E. Phelps ◽

...

Keyword(s):

United States ◽

Chronic Pain ◽

Southeast Asia ◽

The United States ◽

Opioid Use Disorder ◽

Opioid Withdrawal ◽

Opioid Use ◽

Potential Harm ◽

History Of ◽

Chronic Pain Conditions

Kratom (Mitragyna speciosa, Korth.) is an evergreen tree that is indigenous to Southeast Asia. When ingested, kratom leaves or decoctions from the leaves have been reported to produce complex stimulant and opioid-like effects. For generations, native populations in Southeast Asia have used kratom products to stave off fatigue, improve mood, alleviate pain and manage symptoms of opioid withdrawal. Despite the long history of kratom use in Asia, it is only within the past 10–20 years that kratom has emerged as an important herbal agent in the United States, where it is being used for the self-treatment of pain, opioid withdrawal symptoms, and mood disorders. The increase in the use of kratom in the United States has coincided with the serious epidemic of opioid abuse and dependence. Since 2015, efforts to restrict access to prescription opioids have resulted in a marked increase in the use of “street” opioids such as heroin and illicit fentanyl. At the same time, many patients with chronic pain conditions or opioid use disorder have been denied access to appropriate medical help. The lack of access to care for patients with chronic pain and opioid use disorder has been magnified by the emergence of the COVID-19 pandemic. In this report, we highlight how these converging factors have led to a surge in interest in kratom as a potential harm reduction agent in the treatment of pain and opioid use disorder.

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Opioids with abuse-deterrent properties: A regulatory and technological overview

Journal of Opioid Management ◽

10.5055/jom.2017.0417 ◽

2017 ◽

Vol 13 (6) ◽

pp. 397 ◽

Cited By ~ 4

Author(s):

J. David Haddox, DDS, MD

Keyword(s):

Public Health ◽

Intervention Strategy ◽

Opioid Analgesics ◽

The United States ◽

Prescription Opioid ◽

Prescription Opioids ◽

Novel Technologies ◽

Fda Guidance ◽

Federal Food ◽

Prescription Opioid Analgesics

Three concurrent public health problems coexist in the United States: endemic nonmedical use/misuse of opioid analgesics, epidemic overdose fatalities involving opioid analgesics, and endemic chronic pain in adults. These intertwined issues comprise an opioid crisis that has spurred the development of formulations of opioids with abuse-deterrent properties and label claims (OADP). To reduce abuse and misuse of prescription opioids, the federal Food and Drug Administration (FDA) has issued a formal Guidance to drug developers that delineates four categories of testing to generate data sufficient for a description of a product's abuse-deterrent properties, along with associated claims, in its Full Prescribing Information (FPI). This article reviews the epidemiology of the crisis as background for the development of OADP, summarizes the FDA Guidance for Industry regarding abuse-deterrent technologies, and provides an overview of some technologies that are currently employed or are under study for incorporation into OADP. Such technologies include physical and chemical barriers to abuse, combined formulations of opioid agonists and antagonists, inclusion of aversive agents, use of delivery systems that deter abuse, development of new molecular entities and prodrugs, and formulation of products that include some combination of these approaches. Opioids employing these novel technologies are one part of a comprehensive intervention strategy that can deter abuse of prescription opioid analgesics without creating barriers to the safe use of prescription opioids. The maximal public health contribution of OADP will probably occur only when all opioids have FDA-recognized abuse-deterrent properties and label claims.

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