De Facto Long-term Opioid Therapy for Noncancer Pain

Abstract

Objectives This paper describes characteristics of opioid use episodes for non-cancer pain and defines thresholds for the transition into Defacto Long-term Opioid Therapy. Methods CONSORT (CONsortium to Study Opioid Risks and Trends) includes adult members of two health plans serving over one-percent of the U.S. population. Opioid use episodes beginning in 1997–2005 were classified as Acute, Episodic, Long-term/Lower Dose, or Long-term/Higher Dose. Results Defacto Long-term Opioid Therapy was defined by opioid use episodes lasting longer than 90 days with at least 10 prescriptions and/or at least 120 days supply dispensed. Long-term/Higher Dose episodes (<1.5% of all episodes) were characterized by daily or near daily use, a mean duration of about 1000 days, and an average daily dose of about 55 milligrams. They accounted for more than half the total morphine equivalents dispensed from 1997–2006. Short-acting, less potent opioids (e.g. hydrocodone with acetaminophen) were by far the most commonly prescribed medications for acute, episodic and long-term episodes. Long-acting (sustained-release) opioids were the predominately prescribed medication in a minority of long-term episodes (6–12%). Discussion Defacto Long-term Opioid Therapy was characterized by considerable diversity in medications, dosage, and frequency of use. Long-term opioid therapy may evolve from acute or episodic use in the absence of an agreed upon treatment plan. Defined thresholds for Defacto Long-term Opioid Therapy provide a possible check point for physicians and health plans to ensure that patients receiving opioid medications long-term are managed according to a treatment plan that is documented and monitored.

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

“…We defined chronic opioid use as Ban opioid use episode lasting > 90 days with a total of 120+ day supply of opioids or > 10 opioid prescriptions dispensed over 1 year^consistent with prior definitions. [60][61][62] BOpioid day supply^1 year post discharge was calculated by summing opioid fills in 90-day increments per the definition of chronic use. A secondary outcome variable described subsequent opioid refills 1 year post index discharge.…”

Adherence to Clinical Guidelines for Opioid Therapy for Chronic Pain in Patients with Substance Use Disorder

“…24 To be included, patients must have been prescribed chronic opioid therapy, defined as 90 or more consecutive days. 10,25 We identified 28,556 potentially eligible patients. Patients were excluded if they had any cancer diagnosis within the last six years (n=6,234), surgery within the past six months (n=1,597), enrollment in a VA opioid substitution program (n=456), or death in 2008 (n=592).…”

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

“…Standard conversion factors were used to estimate the number of milligrams of morphine equivalents dispensed. 30 To determine the milligrams of morphine equivalents of special formulations, including cough elixirs, transdermal fentanyl, and solutions, we relied on existing literature and then reached consensus, as described in Appendix 1.…”

“…33 Long-term opioid therapy was defined as 90 consecutive days of opioid, allowing for a 30-day refill window. 30 Opioids were categorized into short-acting Schedule II; long-acting Schedule II; and non-schedule II opioids, according to Drug Enforcement Administration classifications. 34 Covariates Socio-demographic variables included gender, race/ethnicity, age and urbanicity based on site of care using ruralurban commuting area codes.…”