Defining Risk of Prescription Opioid Overdose: Pharmacy Shopping and Overlapping Prescriptions Among Long-Term Opioid Users in Medicaid

Yang, Zhuo; Wilsey, Barth; Bohm, Michele K.; Weyrich, Meghan S; Roy, Kakoli; Ritley, Dominique; Jones, Christopher; Melnikow, Joy

doi:10.1016/j.jpain.2015.01.475

Cited by 111 publications

(103 citation statements)

References 21 publications

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“…Prescription opioids are a major cause of opioid‐related death, especially in older adults . PIP is associated with higher odds of nonfatal opioid overdose, fatal opioid overdose, and all‐cause mortality . In our study, age was by far the strongest predictor of undergoing PIP.…”

Section: Discussionmentioning

confidence: 52%

“…Similar to other studies, we identified exposure to 1 or more types of PIP, including: High‐dose opioids, defined according to the daily dose equivalent for each individual in each month in milligram morphine equivalents (MME) (Supplementary Appendix S2). We considered an individual to have received high‐dose opioids if his or her prescriptions averaged MME of 100 mg/d or more in 3 or more separate months. Overlapping opioid and benzodiazepine prescriptions, defined as opioid and benzodiazepine prescriptions that overlapped by at least 1 day in 3 or more separate months. Multiple opioid prescribers, defined as 4 or more opioid prescribers in any 3‐month period. Multiple opioid pharmacies, defined as opioids from 4 or more pharmacies in any 3‐month period. Lack of a documented pain diagnosis, defined as receiving opioids for 3 consecutive months without a pain diagnosis code on a medical service claim (Supplementary Appendix S3). …”

Section: Methodsmentioning

confidence: 99%

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Effect of Age on Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011 to 2015

Rose

McBain

Schuler

et al. 2018

J American Geriatrics Society

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Background/Objectives: Potentially inappropriate opioid prescribing (PIP) may contribute to risk for fatal opioid overdose among older adults (age 50+). Our objective was to examine the effect of age on the likelihood of PIP exposure, as well as the effect of PIP exposure on adverse outcomes. Design: Retrospective cohort study Setting: Data from multiple state agencies in Massachusetts, 2011–2015 Participants: Over 3 million adult Massachusetts residents (3,078,163) who received at least one prescription opioid during the study period; approximately half (1,589,365) were older adults (age 50+). Measurements: We measured exposure to five types of PIP: high-dose opioids, co-prescription with benzodiazepines, multiple opioid prescribers, multiple opioid pharmacies, and continuous opioid therapy without a pain diagnosis. We examined three adverse outcomes: non-fatal opioid overdose, fatal opioid overdose, and all-cause mortality. Results: The rate of any PIP exposure increased with age, ranging from 2% among individuals age 18–29 to 14% among those age 50 and older. Older adults also had elevated rates of exposure to two or more different types of PIP, including 5% of adults age 50–69 and 4% of adults age 70 or older, in comparison to 2.5% of age 40–49 and lower percentages in younger age groups. Among covariates assessed, increasing age was the greatest positive predictor of PIP exposure. In analyses stratified by age, exposure to both any PIP and specific types of PIP were associated with non-fatal overdose, fatal overdose, and all-cause mortality among both younger and older adults. Conclusion: Older adults are more likely to be exposed to PIP, which elevates their risk for adverse events. Strategies to reduce exposure to PIP, and to improve outcomes among those already exposed, will be instrumental to addressing the opioid crisis as it manifests among older adults.

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Section: Discussionmentioning

confidence: 52%

Section: Methodsmentioning

confidence: 99%

Effect of Age on Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011 to 2015

Rose

McBain

Schuler

et al. 2018

J American Geriatrics Society

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“…Finally, data represent prescriptions dispensed in 2012 and 2013 and do not necessarily reflect current dental prescribing. Although the delayed release and analysis of administrative monitoring data is a common concern (28, 38,42,43), one major policy change is not reflected in the results of this study. In October 2014, the DEA, recognizing the high abuse potential of hydrocodone, rescheduled this product to schedule II of the Controlled Substances Act.…”

Section: Discussionmentioning

confidence: 79%

Dental opioid prescribing and multiple opioid prescriptions among dental patients

McCauley¹,

Hyer²,

Ramakrishnan³

et al. 2016

The Journal of the American Dental Association

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Background Despite increased attention to dentists’ role in curbing opioid misuse, abuse, and diversion, information regarding prescribing practices and the frequency of multiple concurrent opioid prescriptions among dental patients is limited. Methods Prescription drug monitoring program (PDMP) data for South Carolina representing dispensed medication for patients prescribed at least one opioid by a dentist over the most recently available two-year frame (2012–2013) was reviewed. Descriptive analyses examined: (1) types, frequency of dental opioid prescriptions; and, (2) frequency of existing multiple concurrent opioid prescriptions among dental patients. Results Nearly all dispensed dental opioid prescriptions (99.9%; n = 653,650) were for immediate release opioids and were initial fills (96.2%). Hydrocodone (76.1%) and oxycodone (12.2%) combination products were the most frequently dispensed opioids prescribed by dentists. Individuals under 21 years of age received 11.2% of dentist prescribed opioids dispensed. Patients with multiple concurrent opioid prescriptions were identified within 30-day (n=113,818), 90-day (n=166,124), and 180-day (n=205,576) timeframes. Conclusions Dentists prescribed a high volume of immediate release opioids dispensed in South Carolina. A notable minority of dental patients had incident(s) of multiple pre-existing opioid prescriptions, a factor implicated in patient misuse, abuse, overdose, and diversion Practical Implications Use of a PDMP prior to prescribing provides a record of controlled substances dispensed to a patient, and may inform prescribing, coordination of care, and addiction screening or referral. Patients should be provided information regarding misuse behaviors and their risks, as well as the importance of secure storage and disposal of leftover opioid medications.

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“…Second, we defined “chronic users” as those consuming more than 100 MMEs per day for more than 90 consecutive days, as there is a strong dose‐response association between the opioid dose and the overdose death risk . Finally, we defined “opioid shoppers” as patients visiting ˃3 pharmacies and ˃3 prescribers to acquire opioids during any 90‐day period because using multiple concurrent prescribers and pharmacies is related to a 600% increase in opioid overdose . Patients not meeting the criterion were considered “low‐risk” by the definition.…”

Section: Methodsmentioning

confidence: 99%

Impact of Florida's prescription drug monitoring program and pill mill law on high‐risk patients: A comparative interrupted time series analysis

Chang

Murimi

Faul

et al. 2018

Pharmacoepidemiology and Drug

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Defining Risk of Prescription Opioid Overdose: Pharmacy Shopping and Overlapping Prescriptions Among Long-Term Opioid Users in Medicaid

Cited by 111 publications

References 21 publications

Effect of Age on Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011 to 2015

Effect of Age on Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011 to 2015

Dental opioid prescribing and multiple opioid prescriptions among dental patients

Impact of Florida's prescription drug monitoring program and pill mill law on high‐risk patients: A comparative interrupted time series analysis

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