Risk factors for drug dependence among out‐patients on opioid therapy in a large US health‐care system

Boscarino, Joseph A.; Rukstalis, Margaret; Hoffman, Stuart N.; Han, John; Erlich, Porat M.; Gerhard, Glenn S.; Stewart, Walter F.

doi:10.1111/j.1360-0443.2010.03052.x

Cited by 329 publications

(277 citation statements)

References 44 publications

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“…We did not try to identify or define dependency, misuse, abuse, or addiction, though these in turn are associated with long-term use. [5][6][7][8]10 Analysis. Chi-square and related tests for trend were used to compare demographic features of patients who did or did not initiate long-term opioid use.…”

Section: Inclusion Of Patients and Prescriptions And Dosingmentioning

confidence: 99%

“…4 For non-cancer conditions, long-term use is problematic because of substantial rates of dependence and misuse, and because efficacy of long-term therapy remains unproven. [5][6][7][8] Emergence of drug tolerance and hyperalgesia may limit long-term efficacy. 9 Several factors may explain the emergence of inadvertent longterm use, including opioid dependence, non-medical use, substance use disorders, and diversion to other users.…”

Section: Introductionmentioning

confidence: 99%

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Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients: A Statewide Retrospective Cohort Study

et al. 2016

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BACKGROUND: Long-term efficacy of opioids for noncancer pain is unproven, but risks argue for cautious prescribing. Few data suggest how long or how much opioid can be prescribed for opioid-naïve patients without inadvertently promoting long-term use. OBJECTIVE: To examine the association between initial opioid prescribing patterns and likelihood of long-term use among opioid-naïve patients. DESIGN: Retrospective cohort study; data from Oregon resident prescriptions linked to death certificates and hospital discharges. PARTICIPANTS: Patients filling opioid prescriptions between October 1, 2012, and September 30, 2013, with no opioid fills for the previous 365 days. Subgroup analyses examined patients under age 45 who did not die in the follow-up year, excluding most cancer or palliative care patients. MAIN MEASURES: Exposure: Numbers of prescription fills and cumulative morphine milligram equivalents (MMEs) dispensed during 30 days following opioid initiation (Binitiation month^). Outcome: Proportion of patients with six or more opioid fills during the subsequent year (Blong-term users^). KEY RESULTS: There were 536,767 opioid-naïve patients who filled an opioid prescription. Of these, 26,785 (5.0 %) became long-term users. Numbers of fills and cumulative MMEs during the initiation month were associated with long-term use. Among patients under age 45 using short-acting opioids who did not die in the follow-up year, the adjusted odds ratio (OR) for long-term use among those receiving two fills versus one was 2.25 (95 % CI: 2.17, 2.33). Compared to those who received < 120 total MMEs, those who received between 400 and 799 had an OR of 2.96 (95 % CI: 2.81, 3.11). Patients initiating with long-acting opioids had a higher risk of long-term use than those initiating with short-acting drugs.CONCLUSIONS: Early opioid prescribing patterns are associated with long-term use. While patient characteristics are important, clinicians have greater control over initial prescribing. Our findings may help minimize the risk of inadvertently initiating long-term opioid use.

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Section: Inclusion Of Patients and Prescriptions And Dosingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients: A Statewide Retrospective Cohort Study

et al. 2016

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“…A world drug report issued by the United Nations Office on Drugs and Crimes estimated that 10−25% of the 24−35 million people who used opioids in 2008 became problem drug users; up to 26% of out-patients on chronic opioid therapy have opioid abuse problems. 4 These reports indicate that pain is no longer a one-dimensional problem; it has become a multidimensional problem 5 due to the use of MOP agonists, which creates significant difficulties for both the patients and society. The total cost of nonmedical use of prescription opioids was estimated at $53.4 billion in 2006.…”

Section: ■ Limitations Of Using Mop Agonistsmentioning

confidence: 99%

The Therapeutic Potential of Nociceptin/Orphanin FQ Receptor Agonists as Analgesics without Abuse Liability

Lin

2012

ACS Chem. Neurosci.

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Although mu opioid (MOP) receptor agonists are the most commonly used analgesics for the treatment of moderate to severe pain in the clinic, the side effects of MOP agonists such as abuse liability limit their value as a medication. Research to identify novel analgesics without adverse effects is pivotal to advance the health care of humans. The nociceptin/ orphanin FQ peptide (NOP) receptor, the fourth opioid receptor subtype, mediates distinctive actions in nonhuman primates which suggests the possibility that activity at this receptor may result in strong analgesia in the absence of virtually all of the side effects associated with MOP agonists. The present review highlights the recent progress of pharmacological studies of NOP-related ligands in primates. Selective NOP agonists, either peptidic or nonpeptidic, produce full analgesia in various assays in primates, when delivered systemically or intrathecally. Yet small molecule NOP agonists do not serve as reinforcers, indicating a lack of abuse liability. Given that NOP agonists have low abuse liability and that coactivation of NOP and MOP receptors produces synergistic antinociception, it is worth developing bifunctional NOP/MOP ligands. The outcomes of these studies and recent developments provide new perspectives to establish a translational bridge for understanding the biobehavioral functions of NOP receptors in primates and for facilitating the development of NOP-related ligands as a new generation of analgesics without abuse liability in humans.

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“…Although the health, economic, and social consequences of the prescription opioid epidemic are broad,7, 8 people with mental illness and non‐opioid addictions show disproportionate risk of suffering serious complications of increased access to prescription opioids 9, 10, 11, 12. Pre‐existing mental illness is major risk factor for acquisition of opioid use disorders, and non‐medical opioid use that escalates to addiction is a risk factor for onset of mental illness 13.…”

Section: Introductionmentioning

confidence: 99%

Prescription drug monitoring program data tracking of opioid addiction treatment outcomes in integrated dual diagnosis care involving injectable naltrexone

et al. 2016

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Background and ObjectivesFourfold increases in opioid prescribing and dispensations over 2 decades in the U.S. has paralleled increases in opioid addictions and overdoses, requiring new preventative, diagnostic, and treatment strategies. This study examines Prescription Drug Monitoring Program (PDMP) tracking as a novel measure of opioid addiction treatment outcomes in a university‐affiliated integrated mental health‐addiction treatment clinic.MethodsRepeated measure parametrics examined PDMP and urine drug screening (UDS) data before and after first injection for all patients (N = 68) who received at least one long‐acting naltrexone injection (380 mg/IM) according to diagnostic groupings of having either (i) alcohol (control); (ii) opioid; or (iii) combined alcohol and opioid use disorders.ResultsThere were no group differences post‐injection in treatment days, injections delivered, or treatment service encounters. UDS and PDMP measures of opioid exposures were greater in opioid compared to alcohol‐only patients. Post‐first injection, UDS's positive for opioids declined (p < .05) along with PDMP measures of opioid prescriptions (p < .001), doses (p < .01), types (p < .001), numbers of dispensing prescribers (p < .001) and pharmacies (p < .001). Opioid patients without alcohol disorders showed the best outcomes with 50% to 80% reductions in PDMP‐measures of opioids, down to levels of alcohol‐only patients.ConclusionsThis study shows PDMP utility for measuring opioid addiction treatment outcomes, supporting the routine use of PDMPs in clinical and research settings.Scientific SignificanceThese findings demonstrate that opioid addiction in patients with complex addictions and mental illnesses comorbidities can show effective treatment responses as measured by PDMP tracking of decreases in opioid prescriptions to those patients. (Am J Addict 2016;25:557–564)

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Risk factors for drug dependence among out‐patients on opioid therapy in a large US health‐care system

Cited by 329 publications

References 44 publications

Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients: A Statewide Retrospective Cohort Study

Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients: A Statewide Retrospective Cohort Study

The Therapeutic Potential of Nociceptin/Orphanin FQ Receptor Agonists as Analgesics without Abuse Liability

Prescription drug monitoring program data tracking of opioid addiction treatment outcomes in integrated dual diagnosis care involving injectable naltrexone

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