Pooja Lagisetty1, Kun Zhang2, Rebecca L Haffajee3, Lewei Allison Lin4, Jason Goldstick5, Rebecca Brownlee6, Amy Bohnert7, Marc R Larochelle8. 1. Department of Internal Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA; Center for Clinical Management and Research, Ann Arbor VA Hospital, 2215 Fuller Road, MS 152, Ann Arbor, MI 48105, USA. Electronic address: lagiset@med.umich.edu. 2. Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC, 4770 Buford Highway, MS F62, Atlanta, GA 30341, USA. 3. Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; RAND Corporation. 4. Center for Clinical Management and Research, Ann Arbor VA Hospital, 2215 Fuller Road, MS 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA. 5. Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA. 6. Department of Psychiatry, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA. 7. Center for Clinical Management and Research, Ann Arbor VA Hospital, 2215 Fuller Road, MS 152, Ann Arbor, MI 48105, USA; Department of Anesthesiology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA. 8. Clinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA 02118, USA.
Abstract
BACKGROUND: Since 2010, heroin-related overdoses have risen sharply, coinciding with policies to restrict access to prescription opioids. It is unknown if patients tapered or discontinued off prescription opioids transitioned to riskier heroin use. This study examined opioid prescribing, including long-term opioid therapy (LTOT) and discontinuation, prior to heroin overdose. METHODS: We used retrospective longitudinal data from a national claims database to identify adults with an emergency or inpatient claim for heroin overdose between January 2010 and June 2017. Receipt of opioid prescription, LTOT episodes, and discontinuation of LTOT were measured for the period of one year prior to heroin overdose. RESULTS: We identified 3183 individuals (53.2% age 18-25; 70.0% male) with a heroin overdose (incidence rate 4.20 per 100k person years). Nearly half (42.3%) received an opioid prescription in the prior 12 months, and 10.9% had an active opioid prescription in the week prior to overdose. LTOT at any time in the 12 months prior to overdose was uncommon (12.8%) among those with heroin overdoses, especially among individuals 18-25 years old (3.5%, P < 0.001). LTOT discontinuation prior to overdose was also relatively uncommon, experienced by 6.7% of individuals aged 46 and over and 2.5% of individuals aged 18-25 years (P < 0.001). CONCLUSIONS: Prior to heroin overdose, prescription opioid use was common, but LTOT discontinuation was uncommon and observed primarily in older individuals with the lowest heroin overdose rates. Further study is needed to determine if these prescribing patterns are associated with increased heroin overdose. Published by Elsevier B.V.
BACKGROUND: Since 2010, heroin-related overdoses have risen sharply, coinciding with policies to restrict access to prescription opioids. It is unknown if patients tapered or discontinued off prescription opioids transitioned to riskier heroin use. This study examined opioid prescribing, including long-term opioid therapy (LTOT) and discontinuation, prior to heroinoverdose. METHODS: We used retrospective longitudinal data from a national claims database to identify adults with an emergency or inpatient claim for heroinoverdose between January 2010 and June 2017. Receipt of opioid prescription, LTOT episodes, and discontinuation of LTOT were measured for the period of one year prior to heroinoverdose. RESULTS: We identified 3183 individuals (53.2% age 18-25; 70.0% male) with a heroinoverdose (incidence rate 4.20 per 100k person years). Nearly half (42.3%) received an opioid prescription in the prior 12 months, and 10.9% had an active opioid prescription in the week prior to overdose. LTOT at any time in the 12 months prior to overdose was uncommon (12.8%) among those with heroinoverdoses, especially among individuals 18-25 years old (3.5%, P < 0.001). LTOT discontinuation prior to overdose was also relatively uncommon, experienced by 6.7% of individuals aged 46 and over and 2.5% of individuals aged 18-25 years (P < 0.001). CONCLUSIONS: Prior to heroinoverdose, prescription opioid use was common, but LTOT discontinuation was uncommon and observed primarily in older individuals with the lowest heroinoverdose rates. Further study is needed to determine if these prescribing patterns are associated with increased heroinoverdose. Published by Elsevier B.V.
Authors: Judith Parsells Kelly; Suzanne F Cook; David W Kaufman; Theresa Anderson; Lynn Rosenberg; Allen A Mitchell Journal: Pain Date: 2008-03-14 Impact factor: 6.961
Authors: Carla A Green; Nancy A Perrin; Brian Hazlehurst; Shannon L Janoff; Angela DeVeaugh-Geiss; David S Carrell; Carlos G Grijalva; Caihua Liang; Cheryl L Enger; Paul M Coplan Journal: Pharmacoepidemiol Drug Saf Date: 2019-04-24 Impact factor: 2.890