Appendix: Impact of the extended-release/long-acting opioid analgesics risk evaluation and mitigation strategy on prescribing practices - Appendix

Matthew H. Secrest, MSc; Syd Phillips, MPH; M. Soledad Cepeda, MD, PhD; David M. Kern, MS, PhD; Daina B. Esposito, MPH, PhD; Gregory P. Wedin, PharmD

doi:10.5055/jom.2023.0764-Appendix

Authors

Matthew H. Secrest, MSc
Syd Phillips, MPH https://orcid.org/0000-0001-9054-8587
M. Soledad Cepeda, MD, PhD
David M. Kern, MS, PhD
Daina B. Esposito, MPH, PhD
Gregory P. Wedin, PharmD

DOI:

https://doi.org/10.5055/jom.2023.0764-Appendix

Keywords:

continuing education, extended-release, long-acting, opioid, opioid abuse, risk evaluation and mitigation strategy

Abstract

Objective: To assess the impact of extended-release (ER)/long-acting (LA) opioid prescriber training on prescribing behaviors.

Design: Retrospective cohort study.

Setting: Prescriber training was evaluated from June 1, 2013 through December 31, 2016. The full study period was 2 years longer, from June 1, 2012 through December 31, 2017, to include data for all prescribers’ 1-year pretraining and post-training periods.

Participants: 24,428 prescribers who wrote ER/LA opioid prescriptions for eligible patients, with a record of training from the partner continuing education provider between June 1, 2013 and December 31, 2016.

Intervention: ER/LA opioid prescriber training. Main outcome measures: Prescribing behaviors 1-year before (pretraining) and after (post-training) prescribers completed training, specifically the proportion of opioid-nontolerant patients receiving ER/LA opioids indicated for opioid-tolerant patients and for patients receiving ≥100 morphine equivalents dose daily, and the proportion of concomitant users of central nervous system depressant drugs.

Results: The differences in the proportion of opioid-nontolerant patients receiving ER/LA opioids indicated for opioid-tolerant patients and for patients receiving ≥100 morphine equivalents dose daily were –0.69 percent (95 percent confidence interval [CI]: –1.78 percent, 0.40 percent) and –0.23 percent (95 percent CI: –1.18 percent, 0.68 percent), respectively. The differences in the proportion of concomitant users of central nervous system depressant drugs were –0.94 percent (95 percent CI: –1.39 percent; –0.48 percent) for benzodiazepines, 0.06 percent (95 percent CI: –0.13 percent; 0.25 percent) for antipsychotics, –0.41 percent (95 percent CI: –0.69 percent; –0.13 percent) for hypnotics/sedatives, and 0.08 percent (95 percent CI: –0.40 percent; 0.57 percent) for muscle relaxants.

Conclusions: While prescribers showed some changes in prescribing behavior after completing training, training was not associated with clinically relevant changes in prescribing behaviors.

Author Biographies

Matthew H. Secrest, MSc

Genentech, San Francisco, California; IQVIA Epidemiology & Drug Safety, Cambridge, Massachusetts

Syd Phillips, MPH

IQVIA Epidemiology & Drug Safety, Cambridge, Massachusetts

M. Soledad Cepeda, MD, PhD

Janssen Epidemiology, Titusville, New Jersey

David M. Kern, MS, PhD

Janssen Epidemiology, Titusville, New Jersey

Daina B. Esposito, MPH, PhD

Ciconia, Inc., Westford; Department of Epidemiology, Boston University, Boston; HealthCore, Inc, Andover, Massachusetts

Gregory P. Wedin, PharmD

Upsher-Smith Laboratories, LLC, Maple Grove, Minnesota

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