Chronic Opioid Therapy: A Scoping Literature Review on Evolving Clinical and Scientific Definitions

Shen, Yun; Bhagwandass, Hemita; Branchcomb, Tychell; Galvez, Sophia A.; Grande, Ivanna; Lessing, Julia; Mollanazar, Mikela; Ourhaan, Natalie; Oueini, Razanne; Sasser, Michael; Valdes, Ivelisse L.; Jadubans, Ashmita; Hollmann, Josef; Maguire, Michael; Usmani, Silken A; Vouri, Scott Martin; Hincapie-Castillo, Juan M.; Adkins, Lauren; Goodin, Amie

doi:10.1016/j.jpain.2020.09.002

Cited by 12 publications

(19 citation statements)

References 233 publications

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“…Lainie et al (24), reported that the implementation of Florida's Prescription Drug Monitoring Program and "pill mill" law was associated with modest reductions in opioid prescribing overall and among patients receiving opioids long-term. A recent study assessed the impact of another state opioid restriction policy change (Tennessee Prescription Regulatory Act) on opioid prescription days' supply among COT patients, and found that the policy change was associated with reductions in number of monthly prescriptions (-1.3%, 95% CI: -3%, -0.07%) and the average days' supply (-5.30 days, 95% CI: -5.64, -4.96), while a significant increase in the average Daily MME was observed (1.41, 95% CI: 0.37, 2.45) (13); however, this study used a cut-point (> 30 days' supply) to define long-term opioid users that is not a typical clinical representation of COT, with a recent review finding that only 7 out of 227 studies defined patients as receiving COT using this more relaxed criterion (18). Additionally, the pre-policy period in that study was only 1 year and may not be sufficient to fully capture the pre-intervention secular trend of patients' opioid prescription patterns in an ITS model.…”

Section: Discussionmentioning

confidence: 93%

“…1). The 70 days' supply cutoff point has been used in previous research to define COT episodes and is among the most widely used COT definitions in recent years (14)(15)(16)(17)(18). Both single-entity and combination products of prescription opioids were identified by generic names and assessed, including: hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, codeine, tramadol, meperidine, fentanyl, pentazocine, and tapentadol.…”

Section: Study Populationmentioning

confidence: 99%

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Chronic Opioid Therapy Utilization Following an Acute Pain Prescription Supply Restriction Law: An Interrupted Time Series Analysis

et al. 2021

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BACKGROUND: Florida House Bill 21 (HB21) was implemented in July 2018 to limit Schedule II opioids prescriptions for patients with acute pain to a 3-day supply. Little is known about the potential unintended effects that such opioid restriction policies may have on chronic pain patients, who are exempt from the law. OBJECTIVE: We aimed to evaluate the effect of HB21 on opioid utilization measures among a cohort of chronic opioid therapy (COT) patients. STUDY DESIGN: A quasi-experimental design with interrupted time series analyses. SETTING: Pharmacy claims from January 1, 2015 to June 31, 2019 from a large employer-based health plan in Florida. METHODS: COT patients were those who received a >= 70 days’ supply of opioids in the prior 90 days, representing 15,310 patients. Interrupted time series analyses were conducted to compare the following monthly measures among COT patients before and after HB21 implementation: 1) number of COT patients, 2) daily Morphine Milligram Equivalents [MMEs], 3) days’ supply of prescriptions. RESULTS: There was a significant 25% reduction in the trend (pre-HB21 RR: 0.95, 95% CI: 0.93, 0.96 versus post-HB21 RR: 0.70, 95% CI: 0.65, 0.76) and an 8% immediate decrease (RR: 0.92, 95% CI: 0.88, 0.97) in the monthly prevalence of COT patients after HB21 implementation. However, no significant change was observed in trends for monthly number of days supplied per prescription, monthly MMEs per COT patient-day, or total MMEs per prescription. LIMITATIONS: Our study used data from employer-based private health insurance and did not include a longer post-policy period to adjust for implementation lag. CONCLUSION: Fewer patients received COT after HB21; however, patients who continued to receive COT experienced no significant changes in their regimen. The study did not assess whether COT patients were appropriately tapered or if therapeutic alternatives were initiated for new chronic pain patients. KEY WORDS: Prescription opioids, health policy evaluation, chronic opioid therapy, drug utilization

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Section: Discussionmentioning

confidence: 93%

Section: Study Populationmentioning

confidence: 99%

Chronic Opioid Therapy Utilization Following an Acute Pain Prescription Supply Restriction Law: An Interrupted Time Series Analysis

et al. 2021

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“… 89 With opioid dose escalation, analgesic and unintended effects emerge asynchronously. While 90 MME may have cautionary mnemonic benefits in the midst of broad societal concern, a renewed emphasis on opioid tolerance and definitional harmonization (for daily MME and long-term therapy 11 , 90 ) seems overdue.…”

Section: Discussionmentioning

confidence: 99%

Inches, Centimeters, and Yards

Dasgupta

Wang

Bae

et al. 2021

The Clinical Journal of Pain

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“…6 In epidemiological studies, the ways of de ning long-term opioid use have varied widely, dramatically reducing comparability, reproducibility and clinical applicability of this research. 5,7,8 Models emulating opioid use persisting more than 90 days are the most frequently used, but how these models are constructed also differs.…”

Section: Introductionmentioning

confidence: 99%

“…23 Three large systematic reviews from recent years have assessed the long-term opioid use de nitions utilized in previous research, coming to similar recommendations for future studies: 1) a cut-off point of >90 days is preferred to de ne long-term opioid use, 2) consistency of the use should be assessed, and 3) sensitivity analyses assessing these de nitions should be applied. 5,7,8 We aimed to create methodology to apply these recommendations to a Nordic setting. We describe the prevalence of long-term opioid use among new users of opioids in Norway between 1st of January 2005 and 31st of October 2019.…”

Section: Introductionmentioning

confidence: 99%

Describing long-term opioid use utilizing Nordic Prescription Registers – A Norwegian example

Hamina¹,

Hjellvik²,

Handal³

et al. 2021

Preprint

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Previous studies have defined long-term opioid use in varying ways, decreasing comparability, reproducibility and clinical applicability of the research. Based on recent systematic reviews, we aimed to estimate long-term opioid use defined as use persisting more than three months using one of the Nordic prescription registers. We used the Norwegian Prescription Register (NorPD) to extract data on all opioid dispensations between January 1st 2004 and October 31st 2019. New users of opioids (washout 365 days) were defined as long-term users if they filled two criteria: 1) they had ≥2 dispensations of opioids, 91-180 days apart; 2) days 0-90 included ≥90 dispensed administration units (e.g., tablets) of opioids. Overall, there were 2,543,224 new users of opioids during the study period. Of these, 354,666 (13.9%) filled the criteria for long-term opioid use at least once. Compared to those who did not fill the criteria (short-term users), long-term users were older, more likely women, and used tramadol, oxycodone, and buprenorphine more frequently as their first opioid. In conclusion, we found that 1/7 of opioid users continued use longer than 3 months. Future outcome research should identify the clinically most important dose requirements for long-term opioid use criteria.

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Chronic Opioid Therapy: A Scoping Literature Review on Evolving Clinical and Scientific Definitions

Cited by 12 publications

References 233 publications

Chronic Opioid Therapy Utilization Following an Acute Pain Prescription Supply Restriction Law: An Interrupted Time Series Analysis

Chronic Opioid Therapy Utilization Following an Acute Pain Prescription Supply Restriction Law: An Interrupted Time Series Analysis

Inches, Centimeters, and Yards

Describing long-term opioid use utilizing Nordic Prescription Registers – A Norwegian example

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