PMID- 34326295
OWN - NLM
STAT- MEDLINE
DCOM- 20220419
LR  - 20230818
IS  - 1872-6623 (Electronic)
IS  - 0304-3959 (Print)
IS  - 0304-3959 (Linking)
VI  - 163
IP  - 4
DP  - 2022 Apr 1
TI  - Associations of opioid prescription dose and discontinuation with risk of 
      substance-related morbidity in long-term opioid therapy.
PG  - e588-e595
LID - 10.1097/j.pain.0000000000002415 [doi]
AB  - Efforts to reduce opioid-related harms have decreased opioid prescription but 
      have provoked concerns about unintended consequences, particularly for long-term 
      opioid therapy (LtOT) recipients. Research is needed to address the knowledge gap 
      regarding how risk of substance-related morbidity changes across LtOT and its 
      discontinuation. This study used nationwide commercial insurance claims data and 
      a within-individual design to examine associations of LtOT dose and 
      discontinuation with substance-related morbidity. We identified 194,839 
      adolescents and adults who initiated opioid prescription in 2010 to 2018 and 
      subsequently received LtOT. The cohort was followed for a median of 965 days 
      (interquartile range, 525-1550), of which a median of 176 days (119-332) were 
      covered by opioid prescription. During follow-up, there were 17,582 acute 
      substance-related morbidity events, defined as claims for emergency visits, 
      inpatient hospitalizations, and ambulance transportation with substance use 
      disorder or overdose diagnoses. Relative to initial treatment, risk was greater 
      within individual during subsequent periods of >60 to 120 (adjusted odds ratio 
      [OR], 1.29; 95% CI, 1.12 to 1.49) and >120 (OR, 1.48; 95% CI, 1.24-1.76) daily 
      morphine milligram equivalents. Risk was also greater during days 1 to 30 after 
      discontinuations than during initial treatment (OR, 1.19; 95% CI, 1.05-1.35). 
      However, it was no greater than during the 30 days before discontinuations, 
      indicating that the risk may not be wholly attributable to discontinuation 
      itself. Results were supported by a negative control pharmacotherapy analysis and 
      additional sensitivity analyses. They suggest that LtOT recipients may experience 
      increased substance-related morbidity risk during treatment subsequent to initial 
      opioid prescription, particularly in periods involving higher doses.
CI  - Copyright (c) 2021 International Association for the Study of Pain.
FAU - Quinn, Patrick D
AU  - Quinn PD
AUID- ORCID: 0000-0002-6770-8762
AD  - Department of Applied Health Science, School of Public Health, Indiana 
      University, Bloomington, IN, United States.
FAU - Chang, Zheng
AU  - Chang Z
AD  - Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 
      Stockholm, Sweden.
FAU - Bair, Matthew J
AU  - Bair MJ
AUID- ORCID: 0000-0002-6374-1370
AD  - VA HSR&D Center for Health Information and Communication, Roudebush VA Medical 
      Center, Indianapolis, IN, United States.
AD  - Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 
      United States.
AD  - Regenstrief Institute, Indianapolis, IN, United States.
FAU - Rickert, Martin E
AU  - Rickert ME
AD  - Department of Psychological and Brain Sciences, Indiana University, Bloomington, 
      IN, United States.
FAU - Gibbons, Robert D
AU  - Gibbons RD
AUID- ORCID: 0000-0002-6463-2280
AD  - Center for Health Statistics, University of Chicago, Chicago, IL, United States.
AD  - Departments of Medicine and.
AD  - Public Health Sciences, University of Chicago, Chicago, IL, United States.
FAU - Kroenke, Kurt
AU  - Kroenke K
AUID- ORCID: 0000-0002-0114-4669
AD  - Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 
      United States.
AD  - Regenstrief Institute, Indianapolis, IN, United States.
FAU - D'Onofrio, Brian M
AU  - D'Onofrio BM
AD  - Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 
      Stockholm, Sweden.
AD  - Department of Psychological and Brain Sciences, Indiana University, Bloomington, 
      IN, United States.
LA  - eng
GR  - R00 DA040727/DA/NIDA NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Pain
JT  - Pain
JID - 7508686
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Analgesics, Opioid/adverse effects
MH  - *Drug Overdose
MH  - Humans
MH  - Morbidity
MH  - *Opioid-Related Disorders/drug therapy/epidemiology
MH  - Prescriptions
MH  - Retrospective Studies
PMC - PMC8795234
MID - NIHMS1725487
COIS- Conflict of Interest Disclosures: None.
EDAT- 2021/07/31 06:00
MHDA- 2022/04/20 06:00
PMCR- 2023/04/01
CRDT- 2021/07/30 05:51
PHST- 2021/03/29 00:00 [received]
PHST- 2021/06/28 00:00 [accepted]
PHST- 2021/07/31 06:00 [pubmed]
PHST- 2022/04/20 06:00 [medline]
PHST- 2021/07/30 05:51 [entrez]
PHST- 2023/04/01 00:00 [pmc-release]
AID - 00006396-202204000-00029 [pii]
AID - 10.1097/j.pain.0000000000002415 [doi]
PST - ppublish
SO  - Pain. 2022 Apr 1;163(4):e588-e595. doi: 10.1097/j.pain.0000000000002415.