Abstract
Opioids are commonly prescribed for acute pain, including treatment of fractures. However, there is risk for dependence and abuse, particularly among opioid-naïve populations. This study used linked claims and electronic medical records to examine the impact of timing of opioid use on outcomes within a fracture population. Individuals with a fracture (index date) between 2012-2017 and continuous eligibility for 6-months preceding and following index were identified in the IBM MarketScan®Explorys®Claims-EMR Dataset. Evidence of fracture or opioid use/dependence during baseline resulted in exclusion. Patients had to have a prescription order for a study opioid (oxycodone, hydrocodone, or tramadol) in the 45 days following index, and a fill for a study opioid anytime during follow-up. Patients were stratified by age (<18; 18-64; and 65+) and time from prescription to first opioid fill (0-7, 8-14, 15-30, and >30 days). Opioid utilization and healthcare costs were compared between sub-groups. A total of 16,181 patients qualified for the study. Mean time from fracture to prescription was 3.5±8.2 days. The majority of the sample (83.6%) filled an opioid within 0-7 days; 7.7% filled >30 days. Patients aged 65+ were more likely than patients <18 to delay opioid fills 30+ days (16.2% vs. 1.6%) and evidenced greater total days’ supply of opioids (36.5±42.1 vs. 6.5±3.0). Compared to patients filling an opioid >30 days from the order, patients filling an opioid within 7 days presented significantly reduced opioid usage (21.2±31.2 vs. 34.9±45.5 days’ supply) and lower fracture-related costs ($9,907±$18,963 vs. $36,321±$85,055; ps< 0.01). Trends in healthcare expenditure were similar across age groups stratified by timing of opioid fill. Although serious risks of opioid use remain, timely utilization of opioids by fracture patients may help manage pain and contain healthcare costs. Once opioids were prescribed, prompt utilization was associated with improved outcomes.
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