Abstract
Introduction: In addition to chronic pain interfering with physical and mental functioning, certain medications used to treat chronic pain may have undesirable effects. A health insurance claims database study was conducted to identify the incidence of two side effects that may be associated with chronic opioid use-constipation and drowsiness-and to compare the risk of developing these conditions. Methods: The California Medicaid (Medi-Cal) database was used to identify the number of chronic pain patients who received a prescription for Duragesic® (fentanyl transdermal system), OxyContin® (oxycodone HCL controlled-release), or codeine between July 1, 1994 and November 30, 1999. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to define constipation (564.0) and drowsiness (780.09). Amphetamine use (defined using NDC codes) was also examined as a marker of drowsiness, since these drugs are likely to be used as a stimulant in drowsy patients. Results: A total of 1,422,427 patients met these criteria, the majority of whom were codeine patients (codeine only = 1,411,251; transdermal fentanyl only = 8,198; oxycodone controlled-release only = 2,978). Oxycodone controlled-release patients had a 58% greater risk of developing constipation compared with transdermal fentanyl (RR = 1.58, p < 0.001); codeine patients had a 26% greater risk of this outcome compared with transdermal fentanyl (RR = 1.26, p = 0.001). Oxycodone controlled-release patients were 34% more likely to be drowsy than transdermal fentanyl patients (RR = 1.34, p = 0.040). Amphetamine use was significantly higher in oxycodone controlled-release patients compared with transdermal fentanyl patients (RR = 2.79, p < 0.001). Amphetamine use in the codeine group was not significantly different from the transdermal fentanyl group. Conclusions: These preliminary findings suggest that patients prescribed Duragesic® (fentanyl transdermal system) have a significantly lower risk of developing constipation or drowsiness compared with OxyContin® (oxycodone HCL controlled-release). Future research will consider the impact of confounding factors-such as age, drug strength, and short-acting opioid usage-on these outcomes.
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