Predicting opioid use disorder and associated risk factors in a Medicaid managed care population

CONTEXT Opioid-related harms continue to rise for children and youth. Analgesic prescribing decisions are challenging because the risk for future nonmedical opioid use or disorder is unclear. OBJECTIVE To synthesize research examining the association between short-term therapeutic opioid exposure and future nonmedical opioid use or opioid use disorder and associated risk factors. DATA SOURCES We searched 11 electronic databases. STUDY SELECTION Two reviewers screened studies. Studies were included if: they were published in English or French, participants had short-term (≤14 days) or an unknown duration of therapeutic exposure to opioids before 18 years, and reported opioid use disorder or misuse. DATA EXTRACTION Data were extracted, and methodologic quality was assessed by 2 reviewers. Data were summarized narratively. RESULTS We included 21 observational studies (49 944 602 participants). One study demonstrated that short-term therapeutic exposure may be associated with opioid abuse; 4 showed an association between medical and nonmedical opioid use without specifying duration of exposure. Other studies reported on prevalence or incidence of nonmedical use after medical exposure to opioids. Risk factors were contradictory and remain unclear. LIMITATIONS Most studies did not specify duration of exposure and were of low methodologic quality, and participants might not have been opioid naïve. CONCLUSIONS Some studies suggest an association between lifetime therapeutic opioid use and nonmedical opioid use. Given the lack of clear evidence regarding short-term therapeutic exposure, health care providers should carefully evaluate pain management options and educate patients and caregivers about safe, judicious, and appropriate use of opioids and potential signs of misuse.

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Persistent Opioid Use After Ophthalmic Surgery in Opioid-Naive Patients and Associated Risk Factors

Ophthalmology ◽

10.1016/j.ophtha.2021.04.021 ◽

2021 ◽

Author(s):

Cindy Ung ◽

Yoshihiro Yonekawa ◽

Jennifer F. Waljee ◽

Vidhya Gunaseelan ◽

Yenling Lai ◽

...

Keyword(s):

Risk Factors ◽

Opioid Use ◽

Ophthalmic Surgery ◽

Associated Risk Factors

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Risk Factors for Treatment Drop-Out: Implications for Adverse Outcomes When Treating Opioid Use Disorder

Journal of Social Work Practice in the Addictions ◽

10.1080/1533256x.2020.1838859 ◽

2020 ◽

Vol 20 (4) ◽

pp. 292-301

Author(s):

Patricia Ann Iovine ◽

David Drachman ◽

Harshal Kirane

Keyword(s):

Risk Factors ◽

Opioid Use Disorder ◽

Adverse Outcomes ◽

Drop Out ◽

Opioid Use

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Pluri Psychopathology and Risk of Opioid Use Disorder

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc/03/07/00004 ◽

2018 ◽

Vol 3 (7) ◽

Keyword(s):

Risk Factors ◽

Chronic Pain ◽

Risk Factor ◽

Cancer Pain ◽

Gender Dysphoria ◽

Psychiatric Comorbidity ◽

Opioid Use Disorder ◽

Opioid Use ◽

Transdermal Fentanyl ◽

Case Presentation

Background: Psychiatric comorbidty is an important risk factor when predicting risk of opioid use disorder in chronic non-cancer pain. We present a case with gender dysphoria, in wich psychiatric comorbidity was not taken into account for de prescription of pharmacological treatment for pain. Case presentation: We report the case of a 51-year-old man with gender dysphoria, personality disorder, chronic pain disorder and opioid use disorder. For the last 9 years he has taken continuousy transdermal fentanyl prescribed by chronic non-cancer pain. Despite of presenting a pluripathology that discouraged the use of opioids in this patient, throughout his evolution, he has gone to different non-psychiatrists and has shown himself with a querulous, confictive and demanding attitude, so that he managed to keep on raising his dose of prescribed opioids. Conclusions: This case shows the importance of knowing the risk factors of consumption due to the use of opioids patients with chronic non-cancer pain, the importance of psychiatric comorbidity associated with prognosis and the neeed to know exactly how opioids are managed by some prescribers, as well as to carry out an interdisciplinary therapeutic plan to avoid risks.

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Predictors of Premature Discontinuation of Opioid Use Disorder Treatment in the United States

10.1101/2021.07.26.21261080 ◽

2021 ◽

Author(s):

Celia Stafford ◽

Wesley Marrero ◽

Rebecca B. Naumann ◽

Kristen Hassmiller Lich ◽

Sarah Wakeman ◽

...

Keyword(s):

Risk Factors ◽

Substance Use ◽

The United States ◽

Opioid Use Disorder ◽

Geographic Region ◽

Influential Factors ◽

Opioid Use ◽

Living Situation ◽

Data Set ◽

Targeted Interventions

Over the last few decades, opioid use disorder (OUD) and overdose have dramatically increased. Evidence shows that treatment for OUD, particularly medication for OUD, is highly effective; however, despite decreases in barriers to treatment, retention in OUD treatment remains a challenge. Therefore, understanding key risk factors for OUD treatment discontinuation remains a critical priority. We built a machine learning model using the Treatment Episode Data Set-Discharge (TEDS-D). Included were 2,446,710 treatment episodes for individuals in the U.S. discharged between January 1, 2015 and December 31, 2018 (the most recent available data). Exposures contain 32 potential risk factors, including treatment characteristics, substance use history, socioeconomic status, and demographic characteristics. Our findings show that the most influential risk factors include characteristics of treatment service setting, geographic region, primary source of payment, referral source, and health insurance status. Importantly, several factors previously reported as influential predictors, such as age, living situation, age of first substance use, race and ethnicity, and sex had far weaker predictive impacts. The influential factors identified in this study should be more closely explored to inform targeted interventions and improve future models of care.

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