Characteristics of patients receiving long-term opioid therapy for chronic noncancer pain: a cross-sectional survey of patients attending the Pain Management Centre at Hamilton General Hospital, Hamilton, Ontario

Busse, Jason W.; Mahmood, Hamza; Maqbool, Bilal; Maqbool, Amna; Zahran, Ali; Alwosaibai, Adnan; Alshaqaq, Eshaq; Persaud, Nav; Cooper, Lynn; Carol, A; Sumpton, Janice E; McGinnis, Erin; Rosenbaum, Daniel M.; Lidster, Natalie; Buckley, D. Norman

doi:10.9778/cmajo.20140126

Cited by 19 publications

(15 citation statements)

References 26 publications

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“…Our observed MME/day is lower than that observed in a study of 889 patients on opioids for CNCP in primary care with a mean of 92 MME/day [ 28 ]. The observed MME/day in our study is significantly lower than the median 180 MME/day observed in a Canadian study of patients attending a specialty chronic pain clinic for CNCP [ 20 ]. Our results also differ from these studies with respect to the most commonly prescribed opioids.…”

Section: Discussioncontrasting

confidence: 89%

“…Published studies have evaluated the content of CSAs [ 13 ], how frequently they are used [ 14 – 16 ], and how frequently enrolled patients abuse opioids [ 17 ]. Previous studies have described patient characteristics and indications for and types of opioids prescribed to patients with CNCP in primary care [ 4 , 18 , 19 ] and in specialty care pain clinics [ 20 ]. However, few published studies [ 19 ] have described the clinical characteristics of patients on CSAs for CNCP and the amount, type and dose of opioids they receive and the degree to which daily dosing exceeds recommendations in the recently released Centers for Disease Control and Prevention (CDC) clinical practice guideline [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Controlled Substance Agreements for Opioids in a Primary Care Practice

Philpot

Ramar

Elrashidi

et al. 2017

J of Pharm Policy and Pract

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BackgroundOpioids are widely prescribed for chronic non cancer pain (CNCP). Controlled substance agreements (CSAs) are intended to increase adherence and mitigate risk with opioid prescribing. We evaluated the demographic characteristics of and opioid dosing for patients with CNCP enrolled in CSAs in a primary care practice.MethodsWe conducted a retrospective cohort study of 1066 patients enrolled in CSAs between May 9, 2013 and August 15, 2016 for CNCP in a Midwest primary care practice.ResultsPatients were prescribed an average of 40.8 (SD ± 57.0) morphine milligram equivalents per day (MME/day), and 21.5% of patients were receiving ≥50 MME/day and 9.7% were receiving ≥90 MME/day. Patients who were younger in age (≥ 65 vs. < 65 years, P < 0.0001), male gender (P = 0.0001), and used tobacco (P = 0.0002) received significantly higher MME/day. Patients with more co-morbidities (Charlson Comorbidity Index, CCI) received higher MME/day (CCI > 3 vs. CCI ≤ 3, P = 0.03), and reported higher average pain (CCI > 3 mean 5.8 [SD ± 2.1] vs. CCI ≤ 3 mean 5.3 [SD ± 2.0], P = 0.0011). Patients on an identified tapering plan (6.9%) had higher MME/day than patients not on a tapering plan (P = 0.0002).ConclusionsCSAs present an opportunity to engage patients taking higher doses of opioids in discussions about opioid safety, appropriate dosing and tapering. CSAs could be leveraged to develop a population health management approach to the care of patients with CNCP.

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Section: Discussioncontrasting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Controlled Substance Agreements for Opioids in a Primary Care Practice

Philpot

Ramar

Elrashidi

et al. 2017

J of Pharm Policy and Pract

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“…In comparison, a recent study showed that patients with chronic non‐cancer pain (CNCP) consumed a median dose of 75 mg OME per day, and only 8.8% of them used less than 20 mg OME daily . The average opioid use among CNCP patients ranges from 20 to 180 mg OME daily and among cancer patients ranges from 30 to 167 mg OME daily (Table ).…”

Section: Discussionmentioning

confidence: 99%

Patterns of opioid use in sickle cell disease

et al. 2016

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Pain, the hallmark complication of sickle cell disease (SCD), is largely managed with opioid analgesics in the United States, but comprehensive data regarding the long-term use of opioids in this patient population is lacking. The pain medication prescription records from a cohort of 203 SCD patients were analyzed. Twenty-five percent were not prescribed opioid medications while 47% took only short-acting opioids, 1% took only long-acting opioids, and 27% took a combination of short-acting and long-acting opioids. The median (interquartile range) daily opioid dose was 6.1 mg (1.7-26.3 mg) of oral morphine equivalents, which is lower than the published opioid use among patients with other pain syndromes. The dose of opioids correlated with the number of admissions due to vaso-occlusive crisis (VOC) (r=0.53, p<0.001). When the patients were grouped into quartiles based on daily dose opioid use, a logistic regression model showed that history of avascular necrosis (AVN) (OR 2.87, 95% CI: 1.37-6.02, p=0.005), 25-OHD levels (OR 0.59, 95% CI: 0.38-0.93, p=0.024) and total bilirubin concentration (OR 0.64, 95% CI: 0.42-0.99, p=0.043) were independently associated with opioid use quartiles. In conclusion, doses and types of opioid medications used by adult SCD patients vary widely. Our findings implicate AVN and lower vitamin D levels as factors associated with higher opioid use. They also suggest an association of higher bilirubin levels, possibly suggesting higher hemolytic rate, with lower opioid use.

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“…Opioid medications were recorded and converted to the equivalent daily dose of oral morphine (MEQ) using previously published conversion ratios (11,12). Prior publications suggest that opioid utilization patterns in chronic pain populations are nonnormally distributed (13,14). To address nonnormalcy, the number and percent of patients using any opioids and the median and interquartile range of opioids use is reported.…”

Section: Methodsmentioning

confidence: 99%