Trajectories of prescription opioids filled over time.

Jonathan Elmer,Eric Hulsey,Michael Lynch,Nikita Setia,Riccardo Fogliato,Daniel Nagin,Wilson Mui,Siyan Yi

doi:10.1371/journal.pone.0222677

Abstract

We performed a retrospective cohort study that aimed to identify one or more groups that followed a pattern of chronic, high prescription use and quantify individuals’ time-dependent probabilities of belonging to a high-utilizer group. We analyzed data from 52,456 adults age 18–45 who enrolled in Medicaid from 2009–2017 in Allegheny County, Pennsylvania who filled at least one prescription for an opioid analgesic. We used group-based trajectory modeling to identify groups of individuals with distinct patterns of prescription opioid use over time. We found the population to be comprised of three distinct trajectory groups. The first group comprised 83% of the population and filled few, if any, opioid prescriptions after their index prescription. The second group (12%) initially filled an average of one prescription per month, but declined over two years to near-zero. The third group (6%) demonstrated sustained high opioid prescriptions utilization. Using individual patients’ posterior probability of membership in the high utilization group, which can be updated iteratively over time as new information become available, we defined a sensitive threshold predictive of sustained future opioid utilization. We conclude that individuals at risk of sustained opioid utilization can be identified early in their clinical course from limited observational data.

Highlights

Morbidity, mortality and social malady resulting from opioid use disorders are major public health concerns in the United States.[1,2] Prescription opioids were a major driver of the first wave of the opioid epidemic, leading to efforts by legislative bodies, governmental agencies and professional medical societies to limit their inappropriate use.[3,4,5,6] Despite potential for misuse, opioids play an important medical role in the management of pain
We found the population to be comprised of three distinct trajectory groups (Fig 1 and S1 Table)
The third group was a small (6%) but clinically important minority of the cohort with sustained high level of opioid prescriptions filled over the duration of observation

Summary

Introduction

Mortality and social malady resulting from opioid use disorders are major public health concerns in the United States.[1,2] Prescription opioids were a major driver of the first wave of the opioid epidemic, leading to efforts by legislative bodies, governmental agencies and professional medical societies to limit their inappropriate use.[3,4,5,6] Despite potential for misuse, opioids play an important medical role in the management of pain. Clinicians are commonly faced with the challenge of identifying patients or patterns of opioid utilization that may suggest risk for future opioid use disorder and other negative medical, social or legal outcomes.

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Conclusion