Commentary on “Methodologic limitations of prescription opioid safety research and recommendations for improving the evidence base”

Association of Opioid Dose Reduction With Opioid Overdose and Opioid Use Disorder Among Patients Receiving High-Dose, Long-term Opioid Therapy in North Carolina

“…3 , 4 , 5 , 6 , 7 , 8 The need for evidence to inform the balancing of these risks and benefits is urgent. 1 , 2 , 9 , 10 , 11 …”

Development and validation of an electronic health records-based opioid use disorder algorithm by expert clinical adjudication

“…The ability to exclude cancer patients and evaluate OUD among non-cancer patients is therefore invaluable. 4,5 Our adjusted OUD prevalence estimates are much higher than estimates from the National Survey on Drug Use and Health (NSDUH) of self-reported OUD and opioid misuse prevalence in the general population. 3 However, note that our estimates are among people who received at least two opioid prescriptions in a six-month period (10.5% of all new patients).…”

“…These estimates and algorithms will allow adjustment of findings from previous studies using quantitative bias correction methods 17,22 and facilitate new research focused on early intervention on OUD prevention and treatment to respond to the ongoing opioid epidemic. [4][5][6][7]…”

“…Another 10 million or more Americans are misusing opioids and are at risk of developing OUD. 3 Even as most opioid research to date has focused on preventing overdose deaths, [4][5][6][7] opioid overdose deaths from prescription and illicit opioids have increased. 1,2 Continued progress in combatting the opioid epidemic requires a shift towards earlier intervention to prevent and treat opioid use disorder.…”

Keeping the Pharmacology in Pharmacoepidemiology

“…This study, conducted using administrative claims data, is subject to the usual limitations of using "big data" to examine drug safety questions, which include lack of detailed clinical data to provide an understanding of the type and severity of the medical conditions being treated and lack of linkage to information about deaths occurring outside of medical treatment, which for opioid overdoses often represents a significant percentage of such deaths. 3 Further, while information on medications and quantities dispensed are available when paid for via the insurance plan, there is no insight into dosage of medications actually taken by patients, which is a key risk factor for overdose. It is possible that these limitations, as well as others, may have precluded the estimation of valid and precise relative risks; the modest elevated risk estimates observed could certainly have been caused by uncontrolled residual confounding.…”