Opioid utilization patterns among patients with cancer and non-cancer pain

Catherine J. Datto, MD, MS; Yiqun Hu, MD, PhD; Eric Wittbrodt, PharmD, MPH; Perry G. Fine, MD

doi:10.5055/jom.2019.0481

Authors

Catherine J. Datto, MD, MS
Yiqun Hu, MD, PhD
Eric Wittbrodt, PharmD, MPH
Perry G. Fine, MD

DOI:

https://doi.org/10.5055/jom.2019.0481

Keywords:

opioid use, opioid dose, cancer pain, non-cancer pain

Abstract

Objective: Opioid pain medication continues to be an important treatment option for patients with moderate to severe cancer and non-cancer pain; however, limited evidence is available regarding differences in opioid use between these two populations. The objective of this analysis was to compare real-world opioid use patterns over time in these two populations.

Design: Retrospective analysis of administrative claims data.

Setting: HealthCore Integrated Research Environment database.

Patients: Adults with ≥1 opioid pharmacy claim (and a confirmed cancer diagnosis for the cancer pain cohort).

Main outcome measures: Opioid doses and dose changes following the initial prescribed (index) dose were determined.

Results: In the cancer pain (n = 9,209) and non-cancer pain (n = 409,703) cohorts, median index opioid doses were 51.7 and 45.0 morphine-equivalent units (MEU), respectively, and median post-index opioid doses were 55.8 and 45.1 MEU for the cancer pain and non-cancer pain cohorts, respectively. The most common dose escalation in both groups was up to a dose doubling (cancer pain, 31.8 percent; non-cancer pain, 28.3 percent). The proportions of patients with dose increases exceeding two times the index dose were low and clinically comparable between cohorts (cancer pain, 9.9 percent; non-cancer pain, 7.4 percent).

Conclusions: Opioid use was consistent between patients with cancer pain and non-cancer pain, including clinically comparable total daily opioid doses and consistent rates of dose escalations and chronic utilization. Opioid medications are an important element of cancer and non-cancer pain management; thus, access to appropriate therapies, use patterns, and risk assessment and management are important for both patient populations.

Author Biographies

Catherine J. Datto, MD, MS

US Medical Affairs Medical Lead, AstraZeneca, Wilmington, Delaware

Yiqun Hu, MD, PhD

Senior Medical Director, AstraZeneca, Wilmington, Delaware

Eric Wittbrodt, PharmD, MPH

Director, Health Economics and Outcomes Research, AstraZeneca, Wilmington, Delaware

Perry G. Fine, MD

Professor of Anesthesiology, Pain Research Center, University of Utah School of Medicine, Salt Lake City, Utah

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