Long-term opioid use and mortality in patients with chronic non-cancer pain: Ten-year follow-up study in South Korea from 2010 through 2019

Song, In-Ae; Choi, Heungho; Oh, Tak Kyu

doi:10.1016/j.eclinm.2022.101558

Cited by 30 publications

(25 citation statements)

References 38 publications

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“…This leaves patients vulnerable to high-risk prescribing and therefore at increased risk of adverse events. Patients on chronic opioids are at increased risk of all-cause mortality compared with nonopioid users, a risk that may be exacerbated in patients who meet multiple criteria for high-risk prescribing 26 . This suggests the need to identify ways in which patients on chronic opioids can safely obtain opioids following surgery to mitigate the risk of adverse events.…”

Section: Discussionmentioning

confidence: 99%

High-risk Prescribing Following Surgery Among Payer Types for Patients on Chronic Opioids

et al. 2023

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Objective: Among those on chronic opioids, to determine whether patients with Medicaid coverage have higher rates of high-risk opioid prescribing following surgery compared with patients on private insurance. Background: Following surgery, patients on chronic opioids experience gaps in transitions of care back to their usual opioid prescriber, but differences by payer type are not well understood. This study aimed to analyze how new high-risk opioid prescribing following surgery compares between Medicaid and private insurance. Methods: In this retrospective cohort study through the Michigan Surgical Quality Collaborative, perioperative data from 70 hospitals across Michigan were linked to prescription drug monitoring program data. Patients with either Medicaid or private insurance were compared. The outcome of interest was new high-risk prescribing, defined as a new occurrence of: overlapping opioids or benzodiazepines, multiple prescribers, high daily doses, or long-acting opioids. Data were analyzed using multivariable regressions and a Cox regression model for return to usual prescriber. Results: Among 1435 patients, 23.6% (95% CI: 20.3%-26.8%) with Medicaid and 22.7% (95% CI: 19.8%-25.6%) with private insurance experienced new, postoperative high-risk prescribing. New multiple prescribers was the greatest contributing factor for both payer types. Medicaid insurance was not associated with higher odds of high-risk prescribing (odds ratio: 1.067, 95% CI: 0.813-1.402). Conclusions: Among patients on chronic opioids, new high-risk prescribing following surgery was high across payer types. This highlights the need for future policies to curb high-risk prescribing patterns, particularly in vulnerable populations that are at risk of greater morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

High-risk Prescribing Following Surgery Among Payer Types for Patients on Chronic Opioids

et al. 2023

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“…2 There are particular concerns about the long-term use of opioids, with known risks including potential dependence and increased mortality. [3][4][5] Previous studies have attempted to quantify rates of long-term opioid use with several approaches and reported varied findings. [6][7][8] Study populations are often heterogenous, excluding people with cancer or opioid use disorder and applying various definitions of long-term use that were determined a priori, resulting in a wide range of estimates of long-term use.…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 3 million individuals in Australia receive dispensed opioids annually, and 1.9 million individuals in Australia initiate a prescription opioid in any given year . There are particular concerns about the long-term use of opioids, with known risks including potential dependence and increased mortality …”

Section: Introductionmentioning

confidence: 99%

Five-Year Trajectories of Prescription Opioid Use

et al. 2023

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ImportanceThere are known risks of using opioids for extended periods. However, less is known about the long-term trajectories of opioid use following initiation.ObjectiveTo identify 5-year trajectories of prescription opioid use, and to examine the characteristics of each trajectory group.Design, Setting, and ParticipantsThis population-based cohort study conducted in New South Wales, Australia, linked national pharmaceutical claims data to 10 national and state data sets to determine sociodemographic characteristics, clinical characteristics, drug use, and health services use. The cohort included adult residents (aged ≥18 years) of New South Wales who initiated a prescription opioid between July 1, 2003, and December 31, 2018. Statistical analyses were conducted from February to September 2022.ExposureDispensing of a prescription opioid, with no evidence of opioid dispensing in the preceding 365 days, identified from pharmaceutical claims data.Main Outcomes and MeasuresThe main outcome was the trajectories of monthly opioid use over 60 months from opioid initiation. Group-based trajectory modeling was used to classify these trajectories. Linked health care data sets were used to examine characteristics of individuals in different trajectory groups.ResultsAmong 3 474 490 individuals who initiated a prescription opioid (1 831 230 females [52.7%]; mean [SD] age, 49.7 [19.3] years), 5 trajectories of long-term opioid use were identified: very low use (75.4%), low use (16.6%), moderate decreasing to low use (2.6%), low increasing to moderate use (2.6%), and sustained use (2.8%). Compared with individuals in the very low use trajectory group, those in the sustained use trajectory group were older (age ≥65 years: 22.0% vs 58.4%); had more comorbidities, including cancer (4.1% vs 22.2%); had increased health services contact, including hospital admissions (36.9% vs 51.6%); had higher use of psychotropic (16.4% vs 42.4%) and other analgesic drugs (22.9% vs 47.3%) prior to opioid initiation, and were initiated on stronger opioids (20.0% vs 50.2%).Conclusions and relevanceResults of this cohort study suggest that most individuals commencing treatment with prescription opioids had relatively low and time-limited exposure to opioids over a 5-year period. The small proportion of individuals with sustained or increasing use was older with more comorbidities and use of psychotropic and other analgesic drugs, likely reflecting a higher prevalence of pain and treatment needs in these individuals.

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“…In particular, high-dose opioid prescription at discharge 6–8 and routine opioid use during the acute postoperative phase 9 could be the cause of long-term use of opioids continuously prescribed over 90 days. 10 …”

Section: Introductionmentioning

confidence: 99%

The Opioid-Sparing Effect of Acupuncture After Abdominal Surgery: A Systematic Review and Meta-Analysis Protocol

Joo¹,

Kim²,

Jang³

et al. 2023

JPR

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Purpose Routine overprescribing of postoperative opioid analgesics may induce side effects and correlate with chronic opioid use following surgery. This review aims to evaluate the effectiveness and safety of acupuncture for opioid-sparing effects in patients who underwent abdominal surgery. Methods Eleven databases in different languages, including English (Ovid MEDLINE, CENTRAL, EMBASE, CINAHL), Chinese, Korean, and Japanese, will be searched. Randomized controlled trials using acupuncture for postoperative pain control in adult patients undergoing abdominal surgery will be screened. All randomized controlled trials comparing acupuncture with no treatment, sham acupuncture, and conventional treatments will be included. The Cochrane risk of bias tool will be used to assess the risk of bias. The primary outcome will consist of a cumulative opioid consumption. Additionally, the number of cumulative opioid analgesic demands/requests, the time to initial opioid analgesic usage, postoperative pain, opioid-related side effects, and adverse events of acupuncture will be assessed. The mean differences or risk ratios with a 95% confidence interval will be calculated to estimate the pooled effect of acupuncture when it is possible to conduct a meta-analysis. Results This study could confirm the effect of opioid-sparing on acupuncture after abdominal surgery. Conclusion This study would evaluate the evidence on the effectiveness of acupuncture after abdominal surgery with a focus on opioid intake. It provides evidence to support decision-making on applying acupuncture for postoperative management. Registration Number CRD42022311155.

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Long-term opioid use and mortality in patients with chronic non-cancer pain: Ten-year follow-up study in South Korea from 2010 through 2019

Cited by 30 publications

References 38 publications

High-risk Prescribing Following Surgery Among Payer Types for Patients on Chronic Opioids

High-risk Prescribing Following Surgery Among Payer Types for Patients on Chronic Opioids

Five-Year Trajectories of Prescription Opioid Use

The Opioid-Sparing Effect of Acupuncture After Abdominal Surgery: A Systematic Review and Meta-Analysis Protocol

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