PURPOSE: To identify and systematically categorize opioid dose reductions and discontinuations in large administrative datasets. METHODS: Using a dataset of Oregon Medicaid beneficiaries linked with prescription drug monitoring program (PDMP) data between 2014 and 2017, we identified patients with high-dose chronic opioid therapy (COT), ≥84 consecutive days with an average daily MME of ≥50 on each of those days. We categorized patients into four mutually exclusive groups based on the trajectory of opioid use in the year after COT: abrupt discontinuation, dose reduction and discontinuation, dose reduction without discontinuation, and stable or increasing dose. Finally, we examined prescription patterns in each category. RESULTS: Among individuals with high-dose COT, 7636 (37.1%) had an abrupt discontinuation, 2577 (12.5%) had a dose reduction and discontinuation, 7739 (37.6%) had a dose reduction without discontinuation, and 2623 (12.8%) had a stable or increasing dose in the year following the COT episode. Among those who discontinued opioid use (n = 10 213, 49.6%), three in four (74.8%) did so without evidence of tapering. Patients who discontinued opioid use were younger, had higher daily MME during COT, and were more likely to have filled a benzodiazepine or had a multiple provider or multiple pharmacy episode compared to patients who did not discontinue opioid use. CONCLUSIONS: Dose reductions and discontinuations after a COT episode can be identified in large administrative datasets. Those with a discontinuation were more likely to have riskier prescription profiles during their COT episode.
PURPOSE: To identify and systematically categorize opioid dose reductions and discontinuations in large administrative datasets. METHODS: Using a dataset of Oregon Medicaid beneficiaries linked with prescription drug monitoring program (PDMP) data between 2014 and 2017, we identified patients with high-dose chronic opioid therapy (COT), ≥84 consecutive days with an average daily MME of ≥50 on each of those days. We categorized patients into four mutually exclusive groups based on the trajectory of opioid use in the year after COT: abrupt discontinuation, dose reduction and discontinuation, dose reduction without discontinuation, and stable or increasing dose. Finally, we examined prescription patterns in each category. RESULTS: Among individuals with high-dose COT, 7636 (37.1%) had an abrupt discontinuation, 2577 (12.5%) had a dose reduction and discontinuation, 7739 (37.6%) had a dose reduction without discontinuation, and 2623 (12.8%) had a stable or increasing dose in the year following the COT episode. Among those who discontinued opioid use (n = 10 213, 49.6%), three in four (74.8%) did so without evidence of tapering. Patients who discontinued opioid use were younger, had higher daily MME during COT, and were more likely to have filled a benzodiazepine or had a multiple provider or multiple pharmacy episode compared to patients who did not discontinue opioid use. CONCLUSIONS: Dose reductions and discontinuations after a COT episode can be identified in large administrative datasets. Those with a discontinuation were more likely to have riskier prescription profiles during their COT episode.
Authors: Daniel M Hartung; Sharia M Ahmed; Luke Middleton; Joshua Van Otterloo; Kun Zhang; Shellie Keast; Hyunjee Kim; Kirbee Johnston; Richard A Deyo Journal: Pharmacoepidemiol Drug Saf Date: 2017-07-19 Impact factor: 2.890
Authors: Kurt Kroenke; Daniel P Alford; Charles Argoff; Bernard Canlas; Edward Covington; Joseph W Frank; Karl J Haake; Steven Hanling; W Michael Hooten; Stefan G Kertesz; Richard L Kravitz; Erin E Krebs; Steven P Stanos; Mark Sullivan Journal: Pain Med Date: 2019-04-01 Impact factor: 3.750
Authors: Joshua J Fenton; Alicia L Agnoli; Guibo Xing; Lillian Hang; Aylin E Altan; Daniel J Tancredi; Anthony Jerant; Elizabeth Magnan Journal: JAMA Netw Open Date: 2019-11-01
Authors: Katrina Hedberg; Lisa T Bui; Catherine Livingston; Lisa M Shields; Joshua Van Otterloo Journal: J Public Health Manag Pract Date: 2019 May/Jun
Authors: Patrick D Quinn; Zheng Chang; Matthew J Bair; Martin E Rickert; Robert D Gibbons; Kurt Kroenke; Brian M D'Onofrio Journal: Pain Date: 2022-04-01 Impact factor: 7.926
Authors: Sara E Hallvik; Sanae El Ibrahimi; Kirbee Johnston; Jonah Geddes; Gillian Leichtling; P Todd Korthuis; Daniel M Hartung Journal: Pain Date: 2022-01-01 Impact factor: 7.926