Short-term healthcare resource utilization associated with receipt of CDC-informed opioid thresholds among commercially insured new chronic opioid users
DOI:
https://doi.org/10.5055/jom.0848Keywords:
chronic opioid use, prescription opioids, healthcare utilization, outcomesAbstract
Objective: To evaluate the impact of recent changes to the Centers for Disease Control and Prevention (CDC) morphine milligram equivalent (MME)/day threshold recommendations on healthcare utilization.
Design: A retrospective cohort study of new chronic opioid users (NCOUs).
Setting: Commercially insured plans across the United States using IQVIA PharMetrics® Plus for Academics database with new use between January 2014 and March 2015.
Patients: NCOUs with ≥60-day coverage of opioids within a 90-day period with ≥30-day opioid-free period prior to the date of the first qualifying opioid prescription.
Interventions: NCOU categorized by the CDC three-tiered risk-based average MME/day thresholds: low (>0 to <50), medium (≥50 to <90), and high (≥90).
Main outcome measures: Multivariable logistic regression was used to calculate adjusted odds of incurring an acute care encounter (ACE) (all-cause and opioid related) between the thresholds (adjusted odds, 95 percent confidence interval).
Results: In adjusted analyses, when compared to low threshold, there was no difference in the odds of all-cause ACE across the medium (1.01, 0.94-1.28) and high (1.01, 0.84-1.22) thresholds. When compared to low threshold, a statistically insignificant increase was observed when evaluating opioid-related ACE among medium (1.86, 0.86-4.02) and high (1.51, 0.65-3.52) thresholds.
Conclusions: There was no difference in odds of an all-cause or opioid-related ACE associated with the thresholds. Early-intervention programs and policies exploring reduction of MME/day among NCOUs may not result in short-term reduction in all-cause or opioid-related ACEs. Further assessment of potential long-term reduction in ACEs among this cohort may be insightful.
References
Dowell D: CDC Clinical Practice Guideline for prescribing opioids for pain—United States, 2022. MMWR Recomm Rep. 2022; 71: 1-95. DOI: 10.15585/mmwr.rr7103a1. DOI: https://doi.org/10.15585/mmwr.rr7103a1
Centers for Disease Control and Prevention: CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016; 65. DOI: 10.15585/mmwr.rr6501e1er. DOI: https://doi.org/10.15585/mmwr.rr6501e1er
Dowell D, Haegerich T, Chou R: No shortcuts to safer opioid prescribing. N Engl J Med. 2019; 380(24): 2285-2287. DOI: 10.1056/NEJMp1904190. DOI: https://doi.org/10.1056/NEJMp1904190
McPherson ML: Demystifying opioid conversion calculations: A guide for effective dosing—NLM Catalog-NCBI. Available at https://www.ncbi.nlm.nih.gov/nlmcatalog/101509913. Accessed August 28, 2019. DOI: https://doi.org/10.37573/9781585284306
Centers for Disease Control and Prevention: Quality Improvement and Care Coordination: Implementing the CDC Guideline for Prescribing Opioids for Chronic Pain. 2018. Atlanta, GA: National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention.
Shen Y, Bhagwandass H, Branchcomb T, et al.: Chronic opioid therapy: A scoping literature review on evolving clinical and scientific definitions. J Pain. 2021; 22(3): 246-262. DOI: 10.1016/j.jpain.2020.09.002. DOI: https://doi.org/10.1016/j.jpain.2020.09.002
IMS HEALTH: Pharmetrics plus data dictionary. 2013. Available at https://tri.uams.edu/wp-content/uploads/sites/80/2015/08/Pharmetrics-Plus-Data-Dictionary-Jan-2013.pdf. Accessed August 28, 2019.
Quinn PD, Hur K, Chang Z, et al.: Incident and long-term opioid therapy among patients with psychiatric conditions and medications: A national study of commercial healthcare claims. Pain. 2017; 158(1): 140-148. DOI: 10.1097/j.pain.0000000000000730. DOI: https://doi.org/10.1097/j.pain.0000000000000730
Jeffery MM, Hooten WM, Henk HJ, et al.: Trends in opioid use in commercially insured and Medicare advantage populations in 2007-16: Retrospective cohort study. BMJ. 2018; 362: K2833. DOI: 10.1136/bmj.k2833. DOI: https://doi.org/10.1136/bmj.k2833
Davis CS, Pierce M, Dasgupta N: Evolution and convergence of state laws governing controlled substance prescription monitoring programs, 1998-2011. Am J Public Health. 2014; 104(8): 1389-1395. DOI: 10.2105/AJPH.2014.301923. DOI: https://doi.org/10.2105/AJPH.2014.301923
Simoni-Wastila GEL: Prescription monitoring programs: Striking the balance between medical use and diversion. J Addict Nurs. 2011; 22(1-2): 77-82. DOI: 10.3109/10884602.2011.551586. DOI: https://doi.org/10.3109/10884602.2011.551586
National Center for Injury Prevention and Control: CDC compilation of benzodiazepines, muscle relaxants, stimulants, zolpidem, and opioid analgesics with oral morphine milligram equivalent conversion factors, 2017 version. 2017. Available at https://www.cdc.gov/drugoverdose/resources/data.html. Accessed June 21, 2021.
Substance Abuse and Mental Health Services Administration (SAMHSA): Methadone. Available at https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-relatedconditions/methadone. Accessed December 20, 2021.
Olopoenia A, Onukwugha E, Simoni-Wastila L, et al.: Patterns of prescription opioid utilization among adolescents and adults with comorbid chronic pain and mental health diagnosis. Pain. 2020; 161(10): 2299-2307. DOI: 10.1097/j.pain.0000000000001934. DOI: https://doi.org/10.1097/j.pain.0000000000001934
Mosher HJ, Jiang L, Vaughan Sarrazin MS, et al.: Prevalence and characteristics of hospitalized adults on chronic opioid therapy. J Hosp Med. 2014; 9(2): 82-87. DOI: 10.1002/jhm.2113. DOI: https://doi.org/10.1002/jhm.2113
Calcaterra SL, Scarbro S, Hull ML, et al.: Prediction of future chronic opioid use among hospitalized patients. J Gen Intern Med. 2018; 33(6): 898-905. DOI: 10.1007/s11606-018-4335-8. DOI: https://doi.org/10.1007/s11606-018-4335-8
Blanchard J, Weiss AJ, Barrett ML, et al.: Readmissions following inpatient treatment for opioid-related conditions. Subs Use Misuse. 2019; 54(3): 473-481. DOI: 10.1080/10826084.2018.1517174. DOI: https://doi.org/10.1080/10826084.2018.1517174
Haffajee RL, Mello MM, Zhang F, et al.: Four states with robust Prescription Drug Monitoring Programs reduced opioid dosages. Health Affairs. 2018; 37(6): 964-974. DOI: 10.1377/hlthaff.2017.1321.
Haffajee RL, Mello MM, Zhang F, et al.: States with overall robust Prescription Drug Monitoring Programs experienced reductions in opioids prescribed to commercially-insured individuals. Health Aff (Millwood). 2018; 37(6): 964-974. DOI: 10.1377/hlthaff.2017.1321. DOI: https://doi.org/10.1377/hlthaff.2017.1321
Liang D, Bao Y, Wallace M, et al.: Medical cannabis legalization and opioid prescriptions: Evidence on US Medicaid enrollees during 1993–2014. Addiction. 2018; 113(11): 2060-2070. DOI: 10.1111/add.14382. DOI: https://doi.org/10.1111/add.14382
Hoppe D, Karimi L, Khalil H: Mapping the research addressing Prescription Drug Monitoring Programs: A scoping review. Drug Alcohol Rev. 2022; 41: 803-817. DOI: 10.1111/dar.13431. DOI: https://doi.org/10.1111/dar.13431
Melfi C, Holleman E, Arthur D, et al.: Selecting a patient characteristics index for the prediction of medical outcomes using administrative claims data. J Clin Epidemiol. 1995; 48(7): 917-926. DOI: 10.1016/0895-4356(94)00202-2. DOI: https://doi.org/10.1016/0895-4356(94)00202-2
Sutradhar R, Lokku A, Barbera L: Cancer survivorship and opioid prescribing rates: A population-based matched cohort study among individuals with and without a history of cancer. Cancer. 2017; 123(21): 4286-4293. DOI: 10.1002/cncr.30839. DOI: https://doi.org/10.1002/cncr.30839
Kobus AM, Smith DH, Morasco BJ, et al.: Correlates of higher-dose opioid medication use for low back pain in primary care. J Pain. 2012; 13(11): 1131-1138. DOI: 10.1016/j.jpain.2012.09.003. DOI: https://doi.org/10.1016/j.jpain.2012.09.003
Gureje O, Von Korff M, Simon GE, et al.: Persistent pain and well-being: A World Health Organization study in primary care. JAMA. 1998; 280(2): 147. DOI: 10.1001/jama.280.2.147. DOI: https://doi.org/10.1001/jama.280.2.147
Owen-Smith A, Stewart C, Sesay MM, et al.: Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness. BMC Psychiatry. 2020; 20(1): 40. DOI: 10.1186/s12888-020-2456-1. DOI: https://doi.org/10.1186/s12888-020-2456-1
Edlund MJ, Martin BC, Devries A, et al.: Trends in use of opioids for chronic non-cancer pain among individuals with mental health and substance use disorders: The TROUP study. Clin J Pain. 2010; 26(1): 1-8. DOI: 10.1097/AJP.0b013e3181b99f35. DOI: https://doi.org/10.1097/AJP.0b013e3181b99f35
Hunnicutt JN, Baek J, Alcusky M, et al.: Geographic variation in the initiation of commonly used opioids and dosage strength in United States nursing homes. Med Care. 2018; 56(10): 847-854. DOI: 10.1097/MLR.0000000000000972. DOI: https://doi.org/10.1097/MLR.0000000000000972
Haymond S, Nagpal G, Heiman H: Urine drug screens to monitor opioid use for managing chronic pain. JAMA. 2017; 318(11): 1061-1062. DOI: 10.1001/jama.2017.10593. DOI: https://doi.org/10.1001/jama.2017.10593
Majestic M: Opioid potentiators memo. 2018. Available at https://mmp.michigancompletehealth.com/content/dam/centene/michigan-complete-health/pdfs/Opioid_Potentiators_Memo.pdf. Accessed April 21, 2020.
Vijay A, Ross JS, Shah ND, et al.: Medicare formulary coverage and restrictions for opioid potentiators from 2013 to 2017. J Gen Intern Med. 2019; 34(4): 518-520. DOI: 10.1007/s11606-018-4752-8. DOI: https://doi.org/10.1007/s11606-018-4752-8
Nielsen S, Lintzeris N, Bruno R, et al.: Benzodiazepine use among chronic pain patients prescribed opioids: Associations with pain, physical and mental health, and health service utilization. Pain Med. 2015; 16(2): 356-366. DOI: 10.1111/pme.12594. DOI: https://doi.org/10.1111/pme.12594
Bruner A, Bokhari A, Fishman M: Opioids and sedative-hypnotics. In Clinical Handbook of Adolescent Addiction. Hoboken, NJ: John Wiley & Sons, Ltd, 2013: 223-236. DOI: 10.1002/9781118340851.ch22. DOI: https://doi.org/10.1002/9781118340851.ch22
Garg RK, Fulton-Kehoe D, Franklin GM: Patterns of opioid use and risk of opioid overdose death among Medicaid patients. Med Care. 2017; 55(7): 661-668. DOI: 10.1097/MLR.0000000000000738. DOI: https://doi.org/10.1097/MLR.0000000000000738
Larochelle MR, Zhang F, Ross-Degnan D, et al.: Trends in opioid prescribing and co-prescribing of sedative hypnotics for acute and chronic musculoskeletal pain: 2001–2010. Pharmacoepidemiol Drug Saf. 2015; 24(8): 885-892. DOI: 10.1002/pds.3776. DOI: https://doi.org/10.1002/pds.3776
Peckham AM, Fairman KA, Sclar DA: All-cause and drug-related medical events associated with overuse of gabapentin and/or opioid medications: A retrospective cohort analysis of a commercially insured US population. Drug Saf. 2018; 41(2): 213-228. DOI: 10.1007/s40264-017-0595-1. DOI: https://doi.org/10.1007/s40264-017-0595-1
Eckhardt K, Ammon S, Hofmann U, et al.: Gabapentin enhances the analgesic effect of morphine in healthy volunteers. Anesth Analg. 2000; 91(1): 185-191. DOI: 10.1213/00000539-200007000-00035. DOI: https://doi.org/10.1213/00000539-200007000-00035
Corey P, Heck AM, Weathermon RA: Amphetamines to counteract opioid-induced sedation. Ann Pharmacother. 1999; 33(12): 1362-1366. DOI: 10.1345/aph.19024. DOI: https://doi.org/10.1345/aph.19024
Ciccarone D: The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Curr Opin Psychiatry. 2021; 34(4): 344-350. DOI: 10.1097/YCO.0000000000000717. DOI: https://doi.org/10.1097/YCO.0000000000000717
Diehr P, Yanez D, Ash A, et al.: Methods for analyzing health care utilization and costs. Annu Rev Public Health. 1999; 20: 125-144. DOI: 10.1146/annurev.publhealth.20.1.125. DOI: https://doi.org/10.1146/annurev.publhealth.20.1.125
Onukwugha E, Bergtold J, Jain R: A primer on marginal effects—Part I: Theory and formulae. PharmacoEconomics. 2015; 33(1): 25-30. DOI: 10.1007/s40273-014-0210-6. DOI: https://doi.org/10.1007/s40273-014-0210-6
Onukwugha E, Bergtold J, Jain R: A primer on marginal effects—Part II: Health services research applications. PharmacoEconomics. 2015; 33(2): 97-103. DOI: 10.1007/s40273-014-0224-0. DOI: https://doi.org/10.1007/s40273-014-0224-0
Mojtabai R: National trends in long-term use of prescription opioids. Pharmacoepidemiol Drug Saf. 2018; 27(5): 526-534. DOI: 10.1002/pds.4278. DOI: https://doi.org/10.1002/pds.4278
Florence CS, Zhou C, Luo F, et al.: The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Medical Care. 2016; 54(10): 901-906. DOI: 10.1097/MLR.0000000000000625. DOI: https://doi.org/10.1097/MLR.0000000000000625
Florence C, Luo F, Rice K: The economic burden of opioid use disorder and fatal opioid overdose in the United States, 2017. Drug Alcohol Depend. 2021; 218: 108350. DOI: 10.1016/j.drugalcdep.2020.108350. DOI: https://doi.org/10.1016/j.drugalcdep.2020.108350
Published
How to Cite
Issue
Section
License
Copyright 2005-2024, Weston Medical Publishing, LLC
All Rights Reserved
