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First Opioid Prescription and Subsequent High-Risk Opioid Use: a National Study of Privately Insured and Medicare Advantage Adults

  • Yongkang Zhang
  • Phyllis Johnson
  • Philip J. Jeng
  • M. Carrington Reid
  • Lisa R. Witkin
  • Bruce R. Schackman
  • Jessica S. Ancker
  • Yuhua Bao
Original Research

Abstract

Background

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.

Objective

To examine associations between features of the first opioid prescription and high-risk opioid use in the 18 months following the first prescription.

Design

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.

Participants

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.

Key Results

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.

Conclusions

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 WORDS

prescription drug abuse pain health services research physician behavior 

Notes

Funding Information

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.

Supplementary material

11606_2018_4628_MOESM1_ESM.docx (1.8 mb)
ESM 1 (DOCX 1.79 mb)

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Yongkang Zhang
    • 1
  • Phyllis Johnson
    • 1
  • Philip J. Jeng
    • 1
  • M. Carrington Reid
    • 2
  • Lisa R. Witkin
    • 3
    • 4
  • Bruce R. Schackman
    • 1
    • 2
    • 5
  • Jessica S. Ancker
    • 1
  • Yuhua Bao
    • 1
    • 5
  1. 1.Department of Healthcare Policy & Research Weill Cornell Medical CollegeNew YorkUSA
  2. 2.Department of MedicineWeill Cornell Medical CollegeNew YorkUSA
  3. 3.Department of AnesthesiologyWeill Cornell Medical CollegeNew YorkUSA
  4. 4.Division of Pain MedicineNew York-Presbyterian/Lower Manhattan HospitalNew YorkUSA
  5. 5.Department of PsychiatryWeill Cornell Medical CollegeNew YorkUSA

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