First Opioid Prescription and Subsequent High-Risk Opioid Use: a National Study of Privately Insured and Medicare Advantage Adults
National guidelines make recommendations regarding the initial opioid prescriptions, but most of the supporting evidence is from the initial episode of care, not the first prescription.
To examine associations between features of the first opioid prescription and high-risk opioid use in the 18 months following the first prescription.
Retrospective cohort study using data from a large commercial insurance claims database for 2011–2014 to identify individuals with no recent use of opioids and follow them for 18 months after the first opioid prescription.
Privately insured patients aged 18–64 and Medicare Advantage patients aged 65 or older who filled a first opioid prescription between 07/01/2011 and 06/30/2013.
Main Outcomes and Measures
High-risk opioid use was measured by having (1) opioid prescriptions overlapping for 7 days or more, (2) opioid and benzodiazepine prescriptions overlapping for 7 days or more, (3) three or more prescribers of opioids, and (4) a daily dosage exceeding 120 morphine milligram equivalents, in each of the six quarters following the first prescription.
All three features of the first prescription were strongly associated with high-risk use. For example, among privately insured patients, receiving a long- (vs. short-) acting first opioid was associated with a 16.9-percentage-point increase (95% CI, 14.3–19.5), a daily MME of 50 or more (vs. less than 30) was associated with a 12.5-percentage-point increase (95% CI, 12.1–12.9), and a supply exceeding 7 days (vs. 3 or fewer days) was associated with a 4.8-percentage-point increase (95% CI, 4.5–5.2), in the probability of having a daily dosage of 120 MMEs or more in the long term, compared to a sample mean of 4.2%. Results for the Medicare Advantage patients were similar.
Long-acting formulation, high daily dosage, and longer duration of the first opioid prescription were each associated with increased high-risk use of opioids in the long term.
KEY WORDSprescription drug abuse pain health services research physician behavior
This study was funded by the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), a National Institute on Drug Abuse Center of Excellence (Grant No. P30DA040500; YB, PJJ, BRS), the National Institute of Mental Health (Grant No. R01MH104200; YB, PJ, PJJ), the National Institute on Aging (Grant Nos. P30AG022845, K24AG053462; MCR), the New York State Health Foundation (Grant No. 17-05047; JSA), the Agency for Healthcare Research and Quality (Grant No. K01HS021531; JSA), and the Weill Cornell Medical College Department of Healthcare Policy and Research (for access to HCCI data).
Compliance with Ethical Standards
This study was approved by the Institutional Review Board of the Weill Cornell Medical College.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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