The Influence of Allowable Refill Gaps on Detecting Long-Term Opioid Therapy: An Analysis of Population-Based Administrative Dispensing Data Among Patients with Knee Arthritis Awaiting Total Knee Arthroplasty

Goplen, C. Michael; Randall, Jason R.; Kang, Sung Hyun; Vakilian, Fatemeh; Jones, Christopher; Voaklander, Donald C.; Beaupré, Lauren A

doi:10.18553/jmcp.2019.25.10.1064

Cited by 3 publications

(6 citation statements)

References 43 publications

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“…Preoperative long-term opioid users (OU) were defined as patients who had 90-days or more of continuous opioid dispensing’s within 180 days prior to surgery. These parameters were consistent with the definition of long-term opioid therapy (LTOT) [ 12 , 13 ]. Preoperative intermittent OU had recorded opioid dispensing’s within the 180 days prior to surgery, but did not meet the threshold parameters for a preoperative long-term OU .…”

Section: Methodssupporting

confidence: 80%

“…Using opioid specific ATC codes, each patient’s PIN profile was queried for 180 days prior to and following the index surgery to determine their opioid dispensing history. The end-date for each dispensing was then calculated by adding the duration of the prescription to the dispensing date for each PIN entry as previously described [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…Individual opioid prescriptions were then converted to a daily MED by multiplying the daily dose for each opioid by the corresponding MED to allow for standardized comparison across different opioid compounds [ 12 ]. Morphine conversion factors were based on the published conversion factors that align with Canadian opioid prescribing guidelines [ 7 ].…”

Section: Methodsmentioning

confidence: 99%

“…The 180-day opioid free period had been previously used in studies investigating LTOT and is the established threshold for opioid discontinuation [ 14 ]. The maximum allowable refill gap between prescriptions in an opioid utilization episode was 14 days, or 0.5 times the preceding prescription length, whichever was greatest [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

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Opioid prescribing practices prior to elective foot and ankle surgery: a population-based evaluation using health administrative data from a tertiary hospital in Canada

et al. 2022

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Background Complex elective foot and ankle surgery is known to be painful so most patients are prescribed opioids at the time of surgery; however, the number of patients prescribed opioids while waiting for surgery in Canada is unknown. Our primary objective was to describe the pre and postoperative prescribing practices for patients in Alberta, Canada undergoing complex elective foot and ankle surgery. Secondarily, we evaluated postoperative opioid usage and hospital outcomes. Methods In this population-based retrospective analysis, we identified all adult patients who underwent unilateral elective orthopedic foot and ankle surgery at a single tertiary hospital between May 1, 2015 and May 31, 2017. Patient and surgical data were extracted from a retrospective chart review and merged with prospectively collected, individual level drug dispensing administrative data to analyze opioid dispensing patterns, including dose, duration, and prescriber for six months before and after foot and ankle surgery. Results Of the 100 patients, 45 had at least one opioid prescription dispensed within six months before surgery, and of these, 19 were long-term opioid users (> 90 days of continuous use). Most opioid users obtained opioid prescriptions from family physicians both before (78%) and after (65%) surgery. No preoperative non-users transitioned to long-term opioid use postoperatively, but 68.4% of the preoperative long-term opioid users remained long-term opioid users postoperatively. During the index hospitalization, preoperative long-term opioid users consumed higher doses of opioids (99.7 ± 120.5 mg/day) compared to opioid naive patients (28.5 ± 36.1 mg/day) (p < 0.001). Long-term opioid users stayed one day longer in hospital than opioid-naive patients (3.9 ± 2.8 days vs 2.7 ± 1.1 days; p = 0.01). Conclusions A significant number of patients were dispensed opioids before and after foot and ankle surgery with the majority of prescriptions coming from primary care practitioners. Patients who were prescribed long-term opioids preoperatively were more likely to continue to use opioids at follow-up and required larger in-hospital opioid dosages and stayed longer in hospital. Further research and education for both patients and providers are needed to reduce the community-based prescribing of opioid medication pre-operatively and provide alternative pain management strategies prior to surgery to improve postoperative outcomes and reduce long-term postoperative opioid use.

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Section: Methodssupporting

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Opioid prescribing practices prior to elective foot and ankle surgery: a population-based evaluation using health administrative data from a tertiary hospital in Canada

et al. 2022

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“…8 Thus, clinical or research applications requiring daily use to define LTO prescribing may be missing or excluding a large and important sub-group of individuals who receive opioids over-extended calendar periods, but at intervals consistent with less than daily use. 9 A better understanding of such yet unexamined sub-groups could result in subsequent research to elucidate clinical trajectories in these sub-groups.…”

Section: Introductionmentioning

confidence: 99%

A Typology of New Long-term Opioid Prescribing in the Veterans Health Administration

et al. 2020

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BACKGROUND: Narrow definitions of long-term opioid (LTO) use result in limited knowledge of the full range of LTO prescribing patterns and the rates of these patterns. OBJECTIVE: To investigate a model of new LTO prescribing typologies using latent class analysis. DESIGN: National administrative data from the VA Corporate Data Warehouse were accessed using the VA Informatics and Computing Infrastructure. Characterization of the typology of initial LTO prescribing was explored using latent class analysis. PARTICIPANTS: Veterans initiating LTO during 2016 through the Veteran's Administration Healthcare System (N = 42,230). MAIN MEASURES: Opioid receipt as determined by VA prescription data, using the cabinet supply methodology. KEY RESULTS: Over one-quarter (27.7%) of the sample fell into the fragmented new long-term prescribing category, 39.8% were characterized by uniform daily new LTO, and the remaining 32.7% were characterized by uniform episodic LTO. Each of these three broad sub-groups also included two additional sub-groups (6 classes total in the model), characterized by the presence or absence of prior opioid prescriptions. CONCLUSIONS: New LTO prescribing in the VA includes uniform daily prescribing, uniform episodic prescribing, and fragmented prescribing. Future work is needed to elucidate the safety and efficacy of these prescribing patterns.

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Impacts of social determinants of health on chronic opioid therapy for chronic non-cancer pain

Chen,

2024

Pain Management

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The Influence of Allowable Refill Gaps on Detecting Long-Term Opioid Therapy: An Analysis of Population-Based Administrative Dispensing Data Among Patients with Knee Arthritis Awaiting Total Knee Arthroplasty

Cited by 3 publications

References 43 publications

Opioid prescribing practices prior to elective foot and ankle surgery: a population-based evaluation using health administrative data from a tertiary hospital in Canada

Opioid prescribing practices prior to elective foot and ankle surgery: a population-based evaluation using health administrative data from a tertiary hospital in Canada

A Typology of New Long-term Opioid Prescribing in the Veterans Health Administration

Impacts of social determinants of health on chronic opioid therapy for chronic non-cancer pain

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