A Comprehensive Approach to Address the Prescription Opioid Epidemic in Washington State: Milestones and Lessons Learned

Franklin, Gary M.; Sabel, Jennifer; Jones, Christopher M.; Mai, Jaymie; Baumgartner, Chris; Banta‐Green, Caleb J.; Neven, Darin; Tauben, David

doi:10.2105/ajph.2014.302367

Cited by 109 publications

(92 citation statements)

References 34 publications

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“…Although our study does not assess underlying causes, the increasing trend in prescription opioid use disorder observed in young adults might be at least partially explained by historical factors described elsewhere in the literature, such as: a shift in medical practice of prescribing opioids from end-of-life pain and cancer to chronic non-cancer pain, particularly in young adults (Franklin et al, 2015); an increased rate of opioid prescription by physicians due to a higher sensitivity to patient’s pain (CDC, 2012); the endorsement of pain as a “fifth vital sign” by the Joint Commission with a controverted pain metric (Franklin et al, 2015); an increased distribution of opioids by the pharmaceutical industry and creation of an opioid rich environment (Rintoul & Dobbin, 2014); state lobbying by pain advocates for prescription opioids use; physician sensitivity to pain exploitation by opioid users; as well as “doctor shopping” by patients (Ballantyne & Kolodny, 2015; CDC, 2012; Shepherd, 2014) and overprescribing (Compton et al, 2016), which leaves excess medications available for misuse or redistribution via nonmedical sanctioned venues. In addition, Friedman suggests that positive media attention, which fosters an image that prescription drug use is a routine aspect of everyday life, together with an increase in the pharmaceutical industry expenditures in direct-to-consumer advertising, has led to growing confidence in the safety of using prescription drugs nonmedically (i.e., ‘normalization” of nonmedical use of these drugs) (Friedman, 2006).…”

Section: Discussionmentioning

confidence: 97%

Prescription opioid use disorder and heroin use among 12-34 year-olds in the United States from 2002 to 2014

Martins

Segura

Santaella-Tenorio

et al. 2017

Addictive Behaviors

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Section: Discussionmentioning

confidence: 97%

Prescription opioid use disorder and heroin use among 12-34 year-olds in the United States from 2002 to 2014

Martins

Segura

Santaella-Tenorio

et al. 2017

Addictive Behaviors

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“…10 Known consequences of this opioid epidemic include abuse and accidental overdose. [11][12][13] A less understood adverse outcome and emerging line of inquiry is the association between opioid use and risk of depression. In a study of nearly 50,000 Veterans Health Administration (VHA) patients, opioid analgesic use of longer than 180 days, compared with 1 to 90 days, was associated with significantly greater risk (hazard ratio [HR] = 1.51; 95% CI, 1.31-1.74) of a new diagnosis for depression.…”

Section: Introductionmentioning

confidence: 99%

Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations

Scherrer

Salas

Copeland

et al. 2016

The Annals of Family Medicine

194

173

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PURPOSE Recent results suggests the risk of a new onset of depression increases with longer duration of opioid analgesic use. It is unclear whether new-onset depression related to opioid analgesic use is a function of the dose prescribed or the duration of use or both.METHODS Using a retrospective cohort design, we collected patient data from 2000 to 2012 from the Veterans Health Administration (VHA), and from 2003 to 2012 from both Baylor Scott & White Health (BSWH) and the Henry Ford Health System (HFHS). Patients (70,997 VHA patients,13,777 BSWH patients,and 22,981 HFHS patients) were new opioid users, aged 18 to 80 years, without a diagnosis of depression at baseline. Opioid analgesic use duration was defined as 1 to 30, 31 to 90, and more than 90 days, and morphine equivalent dose (MED) was defined as 1 to 50 mg/d, 51 to 100 mg/d, and greater than 100 mg/d of analgesic. Pain and other potential confounders were controlled for by inverse probability of treatment-weighted propensity scores.RESULTS New-onset depression after opioid analgesic use occurred in 12% of the VHA sample, 9% of the BSWH sample, and 11% of the HFHS sample. Compared with 1-to 30-day users, new-onset depression increased in those with longer opioid analgesic use. Risk of new-onset depression with 31 to 90 days of opioid analgesic use ranged from hazard ratio [HR] = 1.18 (95% CI, 1.10-1.25) in VHA to HR = 1.33 (95% CI, 1.16-1.52) in HFHS; in opioid analgesic use of more than 90 days, it ranged from HR = 1.35 (95% CI, 1.26-1.44) in VHA to HR = 2.05 (95% CI, 1.75-2.40) in HFHS. Dose was not significantly associated with a new onset of depression.CONCLUSIONS Opioid-related new onset of depression is associated with longer duration of use but not dose. Patients and practitioners should be aware that opioid analgesic use of longer than 30 days imposes risk of new-onset depression. Opioid analgesic use, not just pain, should be considered a potential source when patients report depressed mood. Ann Fam Med 2016;14:54-62. doi: 10.1370/afm.1885. INTRODUCTIOND epression co-occurs with chronic noncancer pain 1,2 and is known to be associated with opioid use. Patients with chronic noncancer pain and depression are more likely than those without depression to receive opioids, 3 have a longer duration of use, 4,5 take them at higher morphine equivalent doses (MEDs), 6 and misuse and or abuse opioids. 7,8 A review of psychopathology in pain 9 suggests the opioid epidemic in the United States reflects underdetected and undertreated mental illness in patients with chronic pain.Every year more than 200 million prescriptions for opioids are written in the United States. 10 Known consequences of this opioid epidemic include abuse and accidental overdose.11-13 A less understood adverse outcome and emerging line of inquiry is the association between opioid use and risk of depression. In a study of nearly 50,000 Veterans Health Administration (VHA) patients, opioid analgesic use of longer than 180 14 In a prospective study of chronic pain patients, thos...

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“…Although there are no magic bullets to address these issues, policy makers play an important role in shaping regulatory, payment and public health policies to reduce opioid-related injuries and deaths (Dhalla et al, 2011b; Franklin et al, 2015; Giraudon et al, 2013; Lyapustina et al, 2016; Stannard, 2013; Stewart and Basler, 2013). Prescriber-oriented interventions, such as updating the guidelines on opioid prescription, have been adopted in many countries, but their penetration is unknown and following the guidelines is not mandatory (Giraudon et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis

Chang

Lyapustina

Rutkow

et al. 2016

Drug and Alcohol Dependence

101

112

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Background Prescription drug monitoring programs (PDMPs) and pill mill laws were implemented to reduce opioid-related injuries/deaths. We evaluated their effects on high-risk prescribers in Florida. Methods We used IMS Health's LRx Lifelink database between July 2010 and September 2012 to identify opioid-prescribing prescribers in Florida (intervention state, N: 38,465) and Georgia (control state, N: 18,566). The pre-intervention, intervention, and post-intervention periods were: July 2010–June 2011, July 2011–September 2011, and October 2011–September 2012. High-risk prescribers were those in the top 5th percentile of opioid volume during four consecutive calendar quarters. We applied comparative interrupted time series models to evaluate policy effects on clinical practices and monthly prescribing measures for low-risk/high-risk prescribers. Results We identified 1526 (4.0%) high-risk prescribers in Florida, accounting for 67% of total opioid volume and 40% of total opioid prescriptions. Relative to their lower-risk counterparts, they wrote sixteen times more monthly opioid prescriptions (79 vs. 5, p < 0.01), and had more prescription-filling patients receiving opioids (47% vs. 19%, p < 0.01). Following policy implementation, Florida's high-risk providers experienced large relative reductions in opioid patients and opioid prescriptions (−536 patients/month, 95% confidence intervals [CI] −829 to −243; −847 prescriptions/month, CI −1498 to −197), morphine equivalent dose (−0.88 mg/month, CI −1.13 to −0.62), and total opioid volume (−3.88 kg/month, CI −5.14 to −2.62). Low-risk providers did not experience statistically significantly relative reductions, nor did policy implementation affect the status of being high- vs. low- risk prescribers. Conclusions High-risk prescribers are disproportionately responsive to state policies. However, opioidsprescribing remains highly concentrated among high-risk providers.

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A Comprehensive Approach to Address the Prescription Opioid Epidemic in Washington State: Milestones and Lessons Learned

Cited by 109 publications

References 34 publications

Prescription opioid use disorder and heroin use among 12-34 year-olds in the United States from 2002 to 2014

Prescription opioid use disorder and heroin use among 12-34 year-olds in the United States from 2002 to 2014

Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations

Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis

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