Methodologic limitations of prescription opioid safety research and recommendations for improving the evidence base

Ranapurwala, Shabbar I.; Naumann, Rebecca B.; Austin, Anna E.; Dasgupta, Nabarun

doi:10.1002/pds.4564

Cited by 40 publications

(69 citation statements)

References 63 publications

(326 reference statements)

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“…Researchers should perform sensitivity analyses around their selected definition of LTOT to evaluate the robustness of their measure. Applying these recommendations will reduce bias and improve the internal validity of studies that examine LTOT as an outcome …”

Section: Discussionmentioning

confidence: 99%

Long‐term opioid therapy definitions and predictors: A systematic review

Karmali

Bush

Raman

et al. 2019

Pharmacoepidemiology and Drug

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Purpose This review sought to (a) describe definitions of long‐term opioid therapy (LTOT) outcome measures, and (b) identify the predictors associated with the transition from short‐term opioid use to LTOT for opioid‐naïve individuals. Methods We conducted a systematic review of the peer‐reviewed literature (January 2007 to July 2018). We included studies examining opioid use for more than 30 days. We classified operationalization of LTOT based on criteria used in the definitions. We extracted LTOT predictors from multivariate models in studies of opioid‐naïve individuals. Results The search retrieved 5,221 studies, and 34 studies were included. We extracted 41 unique variations of LTOT definitions. About 36% of definitions required a cumulative duration of opioid use of 3 months. Only 17% of definitions considered consecutive observation periods, 27% used days' supply, and no definitions considered dose. We extracted 76 unique predictors of LTOT from seven studies of opioid‐naïve patients. Common predictors included pre‐existing comorbidities (21.1%), non‐opioid prescription medication use (13.2%), substance use disorders (10.5%), and mental health disorders (10.5%). Conclusions Most LTOT definitions aligned with the chronic pain definition (pain more than 3 months), and used cumulative duration of opioid use as a criterion, although most did not account for consistent use. Definitions were varied and rarely accounted for prescription characteristics, such as days' supply. Predictors of LTOT were similar to known risk factors of opioid abuse, misuse, and overdose. As LTOT becomes a central component of quality improvement efforts, researchers should incorporate criteria to identify consistent opioid use to build the evidence for safe and appropriate use of prescription opioids.

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Section: Discussionmentioning

confidence: 99%

Long‐term opioid therapy definitions and predictors: A systematic review

Karmali

Bush

Raman

et al. 2019

Pharmacoepidemiology and Drug

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“…We were excited to read “Methodologic limitations of prescription opioid safety research and recommendations for improving the evidence base” by Ranapurwala et al This paper provides a thoughtful assessment of the epidemiologic evidence that has been available to federal agencies, such as the Centers for Disease Control and Prevention (CDC), to inform policies around opioid analgesic prescribing. Given the urgency of the opioid crisis in the United States, public health officials could not wait for high‐quality evidence.…”

Section: Introductionmentioning

confidence: 99%

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

Staffa

Meyer

Secora

et al. 2018

Pharmacoepidemiology and Drug

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“…In 2016, 42,000 Americans lost their lives to opioid overdose, with fentanyl the biggest culprit [18]. Whilst heroin takes second place, it is thought that the indiscriminate prescription of opioids encourages those predisposed to develop addictions, which leads to more recreational drug use [17,18,19]. …”

Section: Management Of Chronic Painmentioning

confidence: 99%

The Current State of Deep Brain Stimulation for Chronic Pain and Its Context in Other Forms of Neuromodulation

2018

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Chronic intractable pain is debilitating for those touched, affecting 5% of the population. Deep brain stimulation (DBS) has fallen out of favour as the centrally implantable neurostimulation of choice for chronic pain since the 1970–1980s, with some neurosurgeons favouring motor cortex stimulation as the ‘last chance saloon’. This article reviews the available data and professional opinion of the current state of DBS as a treatment for chronic pain, placing it in the context of other neuromodulation therapies. We suggest DBS, with its newer target, namely anterior cingulate cortex (ACC), should not be blacklisted on the basis of a lack of good quality study data, which often fails to capture the merits of the treatment.

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Methodologic limitations of prescription opioid safety research and recommendations for improving the evidence base

Abstract: Strengthening the opioid safety evidence base will aid any future revisions of the CDC guidelines and enhance their prevention impact.

Cited by 40 publications

References 63 publications

Long‐term opioid therapy definitions and predictors: A systematic review

Long‐term opioid therapy definitions and predictors: A systematic review

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

The Current State of Deep Brain Stimulation for Chronic Pain and Its Context in Other Forms of Neuromodulation

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