American Journal of Managed Care 2017;23(5):e146-e155.
G.Thomas Ray, MBA (Kaiser Permanente Northern California, HS Node), Amber L. Bahorik, PhD (University of California San Francisco, HS Node), Paul C. VanVeldhuisen, PhD (Emmes Corporation), Constance M. Weisner, DrPh (Kaiser Permanente Northern California, HS Node), Andrea L. Rubinstein, MD (Santa Rosa Medical Center), Cynthia I. Campbell, PhD, MPH (Kaiser Permanente Northern California, HS Node).
The use of prescription opioids has increased dramatically in the past 2 decades, with associated increases in opioid misuse/abuse and opioid overdose. These are among the most commonly prescribed medications, with 259 million prescriptions written for opioid pain relievers in the U.S. in 2012.
This study aimed to establish a prescription opioid registry protocol in a large health system, Kaiser Permanente Northern California (KPNC), and to describe algorithms to characterize individuals using prescription opioids, opioid use episodes, and concurrent use of sedative/hypnotics.
Using KPNC electronic health record data, the investigators selected patients using prescription opioids in 2011. Opioid and sedative/hypnotic fills, and physical and psychiatric comorbidity diagnoses were extracted for years 2008 to 2014. Algorithms were developed to identify each patient's daily opioid and sedative/hypnotic use, and morphine daily-dose equivalent. Opioid episodes were classified as long-term, episodic, or acute. Logistic regression was used to predict characteristics associated with becoming a long-term opioid user.
Results found that in 2011, 18% of KPNC adult members filled at least 1 opioid prescription. Among those patients, 25% used opioids long term and their average duration of use was more than 4 years. Sedative/hypnotics were used by 76% of long-term users. Being older, white, living in a more deprived neighborhood, having a chronic pain diagnosis, and use of sedative/hypnotics were predictors of initiating long-term opioid use.
Conclusions: This study established a population-based opioid registry that is flexible and can be used to address important questions of prescription opioid use. It will be used in future studies to answer a broad range of other critical public health issues relating to prescription opioid use.
(Article (Peer-Reviewed), PDF, English, 2017)
Keywords: Benzodiazepines | Data collection | Older adults | Opioid dependence | Pain management | Prescription-type opiates | American Journal of Managed Care (journal)
Document No: 1271.
Submitted by Andrea Altschuler, PhD, Health Systems Node, 6/15/2017.