Higher Opioid Use Research Articles

Factors Associated with Survey Non-Response in a Cross-Sectional Survey of Persons with an Axial Spondyloarthritis or Osteoarthritis Claims Diagnosis.

Non-response in surveys can lead to bias, which is often difficult to investigate. The aim of this analysis was to compare factors available from claims data associated with survey non-response and to compare them among two samples. A stratified sample of 4471 persons with a diagnosis of axial spondyloarthritis (axSpA) and a sample of 8995 persons with an osteoarthritis (OA) diagnosis from a German statutory health insurance were randomly selected and sent a postal survey. The association of age, sex, medical prescriptions, specialist physician contact, influenza vaccination, hospitalization, and Elixhauser comorbidity index with the survey response was assessed. Multiple logistic regression models were used with response as the outcome. A total of 47% of the axSpA sample and 40% of the OA sample responded to the survey. In both samples, the response was highest in the 70–79-year-olds. Women in all age groups responded more often, except for the 70–79-year-olds. Rheumatologist/orthopedist contact, physical therapy prescription, and influenza vaccination were more frequent among responders. In the logistic regression models, rheumatologist/orthopedist treatment, influenza vaccination, and physical therapy were associated with a higher odds ratio for response in both samples. The prescription of biologic drugs was associated with higher response in axSpA. A high Elixhauser comorbidity index and opioid use were not relevantly associated with response. Being reimbursed for long-term care was associated with lower response—this was only significant in the OA sample. The number of quarters with a diagnosis in the survey year was associated with higher response. Similar factors were associated with non-response in the two samples. The results can help other investigators to plan sample sizes of their surveys in similar settings.

U.S. Military Veteran Versus Nonveteran Use of Licit and Illicit Substances

To provide up-to-date substance use surveillance data among U.S. military veterans versus nonveterans, this study assesses current use of tobacco products, alcohol, marijuana, prescription pain relievers, tranquilizers, sedatives, stimulants, cocaine, heroin, methamphetamines, inhalants, and hallucinogens. Pooled data were from the 2015-2017 National Survey on Drug Use and Health, a nationally representative, self-reported survey of the U.S. adult non-institutionalized population. Military veterans were those who had "ever been in the United States Armed Forces" and were "now separated/retired from reserves/active duty" (n=7,301). Nonveterans were those who had never been in the U.S. Armed forces (n=121,366). Age- and gender-stratified weighted prevalence estimates were calculated and compared with chi-square tests. All analyses were conducted in 2019. Illicit substance use, including marijuana and cocaine, was generally lower among veterans than nonveterans, whereas use of licit substances such as tobacco and alcohol was higher among veterans than nonveterans. The most commonly used substances among veterans were tobacco and alcohol. Among male participants aged 18-25 years, 59.8% of veterans reported past-12-month cigarette/cigar smoking (vs 46.6% of nonveterans), whereas 17.6% reported heavy drinking (vs 12.2% of nonveterans). For both cigarette/cigar smoking and binge drinking, there was a marked narrowing of the male-female gap in prevalence with increasing age among veterans. Female veterans aged 18-25 years reported significantly higher opioid use than their nonveteran counterparts (54.7% vs 35.0%); they also had the highest prevalence of opioid misuse (15.3%) than any other group. Intensified efforts are needed to reduce substance use among veterans and provide cessation and mental health services.

S0741 Younger Age, Concomitant Psychiatric Condition, and Cannabinoid Use Are Linked to the Higher Opioid Use in Patients With Inflammatory Bowel Disease: Nationwide Analysis of More Than 15 Years

S0741 Younger Age, Concomitant Psychiatric Condition, and Cannabinoid Use Are Linked to the Higher Opioid Use in Patients With Inflammatory Bowel Disease: Nationwide Analysis of More Than 15 Years

Real-World Evidence in Prescription Medication Use Among U.S. Adults with Neck Pain.

IntroductionNeck pain is a common condition that leads to serious pain, disability, and increased healthcare costs worldwide. Pharmacotherapy is one of the most common strategies to reduce neck pain in patients. The aim of this study was to analyze the real-world pattern of drugs prescribed for patients with neck pain in the USA.MethodsData on individuals who reported current neck pain in the 2009−2010 US National Health and Nutrition Examination Survey (NHANES) and with a history of persistent pain for at least 6 weeks or 3 months were extracted from the NHANES database. Those included in the study were divided into three groups based on the duration of pain: the without neck pain group (Group A); subacute group (Group B) with a history of 6 weeks of neck pain; and the chronic neck pain group (Group C) with a history of 3 months of neck pain. The use and duration of medication prescribed for Group A, B, and C patients were compared.ResultsThe analysis revealed that opioid use was significantly more prevalent in the subacute and chronic neck pain group than in the without neck pain group (Group A) (adjusted odds ratio [aOR] 4.20, 95% confidence interval [CI] 2.07–8.52 and aOR 7.00, 95% CI 4.32–11.33, respectively). The factors strongly associated with higher opioid use included older age, low education level, and low family income. In the chronic neck group, opioids, followed in decreasing order of frequency by acetaminophen and nonsteroidal anti-infammatory drugs, were the most common analgesics used in combination with other analgesics.ConclusionOur analysis of the data shows that the long-term excessive use of opioids and the underutilization of other analgesics are two major issues in the treatment of neck pain in the USA. Possible improvements include improved education of patients by healthcare professionals on the use of opioids and more consideration given to non-pharmacotherapy options. Our results reveal the potential problem in pharmacotherapy choices for neck pain treatment and may help improve the current clinical practice in the USA and other countries.

Increased risk of adverse events in non-cancer patients with chronic and high-dose opioid use-A health insurance claims analysis.

Chronic and high dose opioid use may result in adverse events. We analyzed the risk associated with chronic and high dose opioid prescription in a Swiss population. Using insurance claims data covering one-sixth of the Swiss population, we analyzed recurrent opioid prescriptions (≥2 opioid claims with at least 1 strong opioid claim) between 2006 and 2014. We calculated the cumulative dose in milligrams morphine equivalents (MED) and treatment duration. Excluded were single opioid claims, opioid use that was cancer treatment related, and opioid use in substitution programs. We assessed the association between the duration of opioid use, prescribed opioid dose, and benzodiazepine use with emergency department (ED) visits, urogenital and pulmonary infections, acute care hospitalization, and death at the end of the episode. In 63,642 recurrent opioid prescription episodes (acute 38%, subacute 7%, chronic 25.8%, very chronic (>360 days) episodes 29%) 18,336 ED visits, 30,209 infections, 19,375 hospitalizations, and 9,662 deaths occurred. The maximum daily MED dose was <20 mg in 15.8%, 20-<50 mg in 16.6%, 50-<100 mg in 21.6%, and ≥100 mg in 46%. Compared to acute episodes (<90 days), episode duration was an independent predictor of ED visits (chronic OR 1.09 (95% CI 1.03-1.15), very chronic (>360 days) OR 1.76 (1.67-1.86)) for adverse effects; infections (chronic OR 1.74 (1.66-1.82), very chronic 4.16 (3.95-4.37)), and hospitalization (chronic: OR 1.22 (1.16-1.29), very chronic OR 1.82 (1.73-1.93)). The risk of death decreased over time (very chronic OR 0.46 (0.43-0.50)). A dose dependent increased risk was observed for ED visits, hospitalization, and death (≥100mg daily MED OR 1.21 (1.13-1.29), OR 1.29 (1.21-1.38), and OR 1.67, 1.50-1.85, respectively). A concomitant use of benzodiazepines increased the odds for ED visits by 46% (OR 1.46, 1.41-1.52), infections by 44% (OR 1.44, 1.41-1.52), hospitalization by 12% (OR 1.12, 1.07-1.1), and death by 45% (OR 1.45, 1.37-1.53). The length of opioid use and higher prescribed morphine equivalent dose were independently associated with an increased risk for ED visits and hospitalizations. The risk for infections, ED visits, hospitalizations, and death also increased with concomitant benzodiazepine use.

32. Preoperative high frequency opioid use dramatically increases complication rate within 90 days, increases two-year reoperation rates, and predisposes to opioid dependency following adult spinal deformity correction

BACKGROUND CONTEXT With a heightened focus on prescription narcotic use in the United States, concern among surgeons has increased regarding preoperative and postoperative usage. However, the literature is scarce on outcomes of preoperative and prolonged opioid usage in adult spinal deformity (ASD) patients. PURPOSE Investigate effect of preoperative opioid usage on prolonged opioid use postoperatively and rates of reoperations. STUDY DESIGN/SETTING Retrospective review of the PearlDiver Database 2008-2013. PATIENT SAMPLE A total of 7,661 ASD patients. OUTCOME MEASURES Reoperations, 90-day complications, comorbidity burden, prolonged opioid usage METHODS ASD patients undergoing a fusion were isolated in the PearlDiver database between the years 2008-2013 using ICD-9 and CPT codes. Patients were stratified by prescription preoperative opioid use 3 months prior to surgery: (1) high frequency (>4 refills); (2) low frequency (1-3 refills); (3) opioid naive. Means comparison tests compared differences in demographics, complications, and reoperation rates. Logistic regression assessed the odds of complication and reoperations associated with preoperative frequency and prolonged opioid use (3 to 6 months postop), controlling for age, sex, and comorbidities. RESULTS A total of 7,661 ASD patients were isolated; 2,342 patients were high frequency preop opioid users, 2,247 low frequency preop opioid users, and 3,072 opioid naive. At BL, high frequency preop opioid users had higher rates of obesity, diabetes mellitus, CHF, COPD, hypertension, smoking and alcohol use (all p CONCLUSIONS Patients with high frequency preoperative opioid use are at increased risk of major complications within 90 days of surgery, prolonged use postoperatively, and increased risk of reoperations within two years. During preoperative risk assessment, providers should consider the effect of pre- and postoperative opioid usage on patient outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Differences in patient characteristics and external validity of randomized clinical trials on pain management following total hip and knee arthroplasty: a systematic review

BackgroundThe external validity of randomized controlled trials (RCTs) is critical for the relevance of trial results in a clinical setting. We aimed to assess the external validity of RCTs investigating...

Abstract 5769: Opioid prescription characteristics associated with frequent emergency department use among hospitalized cancer patients: a comparative cohort study

Abstract Background: Opioid use is associated with greater health resource utilization, namely unplanned emergency department (ED) visits. The purpose of this study was to characterize ED visit patterns by patients hospitalized for cancer based on their use of prescription opioids in the community. Design &amp; Methods: A prospective cohort study of cancer patients discharged from medical and surgical units at an academic health center in Montreal (Canada) between October 2014 and November 2016 was assembled. The main outcome was frequent ED use (≥4 ED visits) in the year following hospital discharge. Clinical information linked to health administrative claims from the provincial universal health care program (RAMQ) was used in multivariable logistic regression to model patient and opioid prescription characteristics, comparing frequent ED users to non-frequent ED users. Potential predictors included history of chronic pain condition, mental health diagnoses, type of cancer, receipt of radiotherapy/chemotherapy, medication history (previous use of opioids, history of antidepressant use, benzodiazepines), receipt of surgery during the hospitalization as well as characteristics of the discharge prescription (e.g: receipt of an opioid, presence of a multi-modal pain regimen). Results: A cohort of 1253 cancer patients discharged from the medical and surgical units was assembled. The mean age for these patients was 70.9 (11.8) and the most frequent cancers included 488 (38.9%) respiratory and 309 (24.6%) upper digestive cancer. Overall, 54% of cancer patients (n =654) had at least one ED visit in the year post-discharge. Of these, all had filled at least one opioid prescription during the follow-up period. Of patients with at least one ED visit in the one year post-discharge, 29% (n = 188) became frequent ED users. In adjusted multivariable logistic model, the strongest associations of frequent ED use were receipt of chemotherapy one year before their index hospitalization (odds ratio (OR) 1.67; 95% CI: 1.08 - 2.61) and respiratory cancer diagnoses (OR 1.69; 95% CI: 1.07 - 2.67). With respect to opioid prescribing, most the dispensations were for oxycodone (51.4%) and hydromorphone (33.6%). Patients receiving a daily dose &amp;gt;90 MME (morphine milligram equivalents) had an odds ratio of 2.24 (95% CI: 1.14- 4.40) of becoming frequent ED users. Those who filled more than one type of opioid during the follow-up were 1.81 times more likely to become repeated ED users (95% CI: 1.23 - 2.70). Conclusions: Cancer patients with higher opioid use after hospital discharge and active use of more than two different type of opioids within one year time of discharge are at higher risk of encoring unplanned health visits in the ER. A new approach to care planning and coordination is recommended to better monitor opioid prescribing practices and improve outcomes. Citation Format: Siyana Kurteva, Robyn Tamblyn, Ari Meguerditchian. Opioid prescription characteristics associated with frequent emergency department use among hospitalized cancer patients: a comparative cohort study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5769.

A multi-center analysis of cumulative inpatient opioid use in colorectal surgery patients

BackgroundThere are little data on risk factors for increased inpatient opioid use and its relationship with persistent opioid use after colorectal surgery. MethodsWe identified colorectal surgery patients across five collaborating institutions. Patient comorbidities, surgery data, and outcomes were captured in the American College of Surgeons National Surgical Quality Improvement Program. We recorded preoperative opioid exposure, inpatient opioid use, and persistent use 90–180 days after surgery. Results1646 patients were analyzed. Patients receiving ≥250 MMEs (top quartile) were included in the high use group. On multivariable analysis, age <65, emergent surgery, inflammatory bowel disease, and postoperative complications, but not prior opioid exposure, were predictive of high opioid use. Patients in the top quartile of use had an increased risk of persistent opioid use (19.8% vs. 9.7%, p < 0.001), which persisted on multivariable analysis (OR 1.48; p = 0.037). ConclusionsWe identified risk factors for high inpatient use that can be used to identify patients that may benefit from opioid sparing strategies. Furthermore, high postoperative inpatient use was associated with an increased risk of persistent opioid use.

Characteristics and potential biomarkers of adult sickle cell patients with chronic pain.

In this study, we investigated the evolution of chronic pain in sickle cell patients (SCD) as an age-dependent phenomenon and studied the frequency of vaso-occlusive episode frequency, opioid use, quantitative sensory testing (QST), and biomarkers of chronic pain (CP). We undertook a cross-sectional study of the evolution of CP in SCD. A total of 72 subjects (age 15-66) were enrolled. VOE frequency, presence of CP hydroxyurea (HU) therapy, opioid use, and laboratory parameters were collected. QST was performed, and plasma tryptase, substance P, and NGF (Nerve Growth Factor) levels were assayed. There was an age-dependent increase in frequency of CP, VOEs, opioid use, and Von Frey monofilament values. CP patients had significantly higher opioid use (daily morphine equivalents) (52.8mg vs 6.94mg, P=.009), suggesting a correlation between opioid use and hyperalgesia. NGF levels were also significantly higher (P=.051). Our results confirm previous observations of an age-dependent increase in the proportion of patients with CP and support the contributing role of mast cell activation and neurogenic inflammation. This is the first study of NGF as a possible biomarker of CP in SCD. If confirmed, this could provide a diagnostic marker and therapeutic target for CP in SCD.

Perioperative Serum 25-Hydroxyvitamin D Levels as a Predictor of Postoperative Opioid Use and Opioid Use Disorder: a Cohort Study.

Vitamin D deficiency is associated with chronic pain syndromes and higher opioid use among cancer patients, but its association with opioid use among opioid-naïve subjects following a major surgical procedure with acute pain has not been explored. To determine the association between serum 25-hydroxyvitamin D (25(OH)D) levels, opioid use, and opioid use disorder. We identified commercially insured subjects aged 18-64years with available perioperative serum 25-hydroxyvitamin D (25D) levels who underwent one of nine major surgical procedures in 2000-2014. Primary outcomes were dose and duration of opioid use measured using pharmacy claims. Secondary outcome was opioid use disorder captured using diagnosis codes. Multivariable negative binomial models with generalized estimating equations were performed examining the association between 25D levels and postoperative opioid use measures, adjusting for age, sex, race/ethnicity, Charlson score, education, income, latitude, and season of blood draw. Adjusted Cox regression was used to examine the association with opioid use disorder. Among 5446 subjects, serum 25(OH)D was sufficient (≥ 20ng/mL) among 4349 (79.9%) subjects, whereas 837 (15.4%) had insufficient (12 to < 20ng/mL) and 260 (4.8%) had deficient (< 12ng/mL) levels. On multivariable analysis, as compared with subjects with sufficient 25(OH)D levels, subjects with deficient 25(OH)D levels had 1.7 more days (95% CI 0.76, 2.58) of opioid use per year and had 98.7 higher morphine milligram equivalent dose (95% CI 55.7, 141.8) per year. Among 11,713 study cohort, subjects with deficient 25(OH)D levels were more likely to be diagnosed with opioid use disorders (HR 2.41; 95% CI 1.05, 5.52). Patients undergoing common surgical procedures with deficient 25D levels are more likely to have higher opioid use and an increased risk of opioid use disorder compared to those with sufficient levels. Serum 25D levels may serve as a biomarker to identify subjects at increased risk of opioid misuse.

Opioid use disorders and hospital palliative care among patients with gastrointestinal cancers: Ten-year trend and associated factors in the U.S. from 2005 to 2014.

This study aimed to analyze the trends of opioid use disorders, cannabis use disorders, and palliative care among hospitalized patients with gastrointestinal cancer and to identify their associated factors.We analyzed the National Inpatient Sample data from 2005 to 2014 and included hospitalized patients with gastrointestinal cancers. The trends of hospital palliative care and opioid or cannabis use disorders were analyzed using the compound annual growth rates (CAGR) with Rao-Scott correction for χ tests. Multivariate logistic regression analyses were performed to identify the associated factors.From 2005 to 2014, among 4,364,416 hospitalizations of patients with gastrointestinal cancer, the average annual rates of opioid and cannabis use disorders were 0.4% (n = 19,520), and 0.3% (n = 13,009), respectively. The utilization rate of hospital palliative care was 6.2% (n = 268,742). They all sharply increased for 10 years (CAGR = 9.61%, 22.2%, and 21.51%, respectively). The patients with a cannabis use disorder were over 4 times more likely to have an opioid use disorder (Odds ratios, OR = 4.029; P < .001). Hospital palliative care was associated with higher opioid use disorder rates, higher in-hospital mortality, shorter length of hospital stay, and lower hospital charges. (OR = 1.527, 9.980, B = -0.054 and -0.386; each of P < .001)The temporal trends of opioid use disorders and hospital palliative care use among patients with gastrointestinal cancer increased from 2005 to 2014, which is mostly attributed to patients with a higher risk of in-hospital mortality. Cannabis use disorders were associated with opioid use disorders. Palliative care was associated with both reduced lengths of stay and hospital charge.

Abstract A19: Opioid prescriptions in the military defense system head and neck cancer population, FY2007 - FY2014

Abstract Purpose: Head and neck cancer (HNC) pain involves nocioceptive and neuropathic inputs from both disease and treatment into a highly innervated area of the body. Hence, opioids are assumed to be used in the pain management of HNC patients. Here, we examine the rates and correlates of opioids prescribed to HNC patients who are beneficiaries of the U.S. Military Health System (MHS). Methods: We used MHS outpatient, inpatient, and pharmacy claims data, fiscal years (FY) 2007-2014, to ascertain beneficiaries with a primary ICD-9 diagnosis of HNC. Descriptive statistics were used to characterize the population with respect to sociodemographic characteristics, location and source of care, comorbid conditions, and number of filled opioid prescriptions. Analysis of variance and multiple regression were used to identify trends and predictors of the number of opioid agonist prescription(s) per year. Results: On average per year, 2,944 nonelderly MHS beneficiaries with a primary diagnosis of HNC submitted claims to TRICARE. Most were age 55-64, male, lived in southeast U.S., and received health care in civilian settings only. On average, 0.7% and 12.2% had a concurrent diagnosis indicative of a drug use disorder or alcohol use disorder, respectively, and 26.1% had a documented history of tobacco use. About 44% had head and neck surgery, 84% received radiation therapy, 43% received chemotherapy, and 15% accessed hospice care. On average, 57% of HNC patients received at least 1 opioid agonist prescription per year; this rate was stable over the 8 years of observation. Annual average number of opioid agonist prescriptions per patient ranged from 6.27 (fiscal years 2010 and 2013) to 6.73 (fiscal year 2012). Based on regression analysis, the strongest predictors (p &amp;lt; 0.001) of the number of opioid prescriptions were: hospice use (99% CI 2.236, 2.856), anxiety (99% CI 2.298, 3.063), drug use disorder (99% CI 7.351, 9.992), depression (99% CI 1.692. 2.363), head and neck surgery (99% CI 0.993, 1.434), chemotherapy, tobacco use, number of physical comorbidities, age, and adjustment disorder. Discussion: The results indicate that the average HNC patient treated in the community receives 6 opioid prescriptions per year. This amount, known to increase risk for prolonged opioid use, is largely related to end-of-life care and mental health and drug use disorders. HNC surgery, while significant, was not as strong a predictor. While high opioid use is expected in end-of-life care, the results suggest that all HNC patients need to be regularly screened for mental health comorbidities, particularly drug use disorders. We recommend that oncologists and primary care providers of HNC patients follow guidelines and develop management plans specific to opioid prescribing such as those found in the Veterans Administration/Department of Defense Clinical Practice Guidelines for Opioid Therapy for Chronic Pain, v. 3.0. Citation Format: Art A. Ambrosio, Diana D. Jeffery, Laura A. Hopkins, Christopher J. Spevak, Harry B. Burke. Opioid prescriptions in the military defense system head and neck cancer population, FY2007 - FY2014 [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr A19.

Association between psychotropic drug use and prescription opioid use among older adults

This study investigated the association between psychotropic drug use and prescription opioid use/high dosage opioid use among older adults. A sample of 203,750 older adults enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) program during 2017 was evaluated for prescription opioid and psychotropic drug usage. High dosage opioid use was defined as using >90 morphine milligram equivalents (MME)/day for ≥90 consecutive days. Overall, 20.7% of enrollees filled opioid prescriptions, of which 1.4% used them at high dosages. Multivariate logistic regression indicated that the odds of prescription opioid use increased with anxiolytic/sedative/hypnotic use and antidepressant use. Moreover, high dosage opioid use was significantly associated with anxiolytic/sedative/hypnotic use, antidepressant use and other factors including being younger, male, white, and married but living separately, and having multiple opioid prescribers. Clinicians should carefully evaluate opioid use among older patients using anxiolytics or antidepressants to minimize risks for adverse consequences of opioids.

Impact of Pain, Opioids, and the Mu-opioid Receptor on Progression and Survival in Patients With Newly Diagnosed Stage IV Pancreatic Cancer.

Pancreatic adenocarcinoma is frequently associated with pain requiring opioid therapy. Opioids, however, have been implicated in causing tumor progression, ultimately shortening survival. We examined the impact of pain, opioid use, and the mu-opioid receptor (MOP-R) expression in tumor tissue on progression-free survival and overall survival of patients with metastatic pancreatic cancer. We identified 103 patients with metastatic pancreatic adenocarcinoma receiving chemotherapy and abstracted data from Tumor Registry, in addition to pain, opioid exposure, carbohydrate antigen 19-9 values, survival, and imaging response. MOP-R expression was evaluated using an immunohistochemistry assay. The association of variables with progression-free survival and overall survival was analyzed in univariate and multivariate models. Patients with low opioid use (<5 mg oral morphine equivalent/d) survived longer than patients with high opioid (HO) use (≥5 mg oral morphine equivalent/d) (median overall survival of 315 vs. 150 d; hazard ratio [HR]=1.79; 95% confidence interval [CI]: 1.13, 2.84). This effect persisted on multivariate models (adjusted HR=2.76; 95% CI: 1.39, 5.48). Low opioid patients tended to respond better to treatment than HO patients, based on carbohydrate antigen 19-9. Patients with low MOP-R expression had longer median survival (230 vs. 193 d), though the HR was not significant (1.15; 95% CI: 0.71, 1.88). Baseline pain was not associated with outcomes. In patients with metastatic pancreatic adenocarcinoma, HO use is associated with decreased survival, but the severity of baseline pain and MOP-R expression score in tumor tissue does not correlate with clinical outcomes.

A predictive-modeling based screening tool for prolonged opioid use after surgical management of low back and lower extremity pain

BACKGROUND CONTEXTOutpatient postoperative pain management in spine patients, specifically involving the use of opioids, demonstrates significant variability. PURPOSEUsing preoperative risk factors and 30-day postoperative opioid prescribing patterns, we developed models for predicting long-term opioid use in patients after elective spine surgery. STUDY DESIGN/SETTINGThis retrospective cohort study utilizes inpatient, outpatient, and pharmaceutical data from MarketScan databases (Truven Health). PATIENT SAMPLEIn all, 19,317 patients who were newly diagnosed with low back or lower extremity pain (LBP or LEP) between 2008 and 2015 and underwent thoracic or lumbar surgery within 1 year after diagnosis were enrolled. Some patients initiated opioids after diagnosis but all patients were opioid-naïve before the diagnosis. OUTCOME MEASURESLong-term opioid use was defined as filling ≥180 days of opioids within one year after surgery. METHODSUsing demographic variables, medical and psychiatric comorbidities, preoperative opioid use, and 30-day postoperative opioid use, we generated seven models on 80% of the dataset and tested the models on the remaining 20%. We used three regression-based models (full logistic regression, stepwise logistic regression, least absolute shrinkage and selection operator), support vector machine, two tree-based models (random forest, stochastic gradient boosting), and time-varying convolutional neural network. Area under the curve (AUC), Brier index, sensitivity, and calibration curves were used to assess the discrimination and calibration of the models. RESULTSWe identified 903 (4.6%) of patients who met criteria for long-term opioid use. The regression-based models demonstrated the highest AUC, ranging from 0.835 to 0.847, and relatively high sensitivities, predicting between 74.9% and 76.5% of the long-term opioid use patients in the test dataset. The three strongest positive predictors of long-term opioid use were high preoperative opioid use (OR 2.70; 95% confidence interval [CI] 2.27–3.22), number of days with active opioid prescription between postoperative days 15 to 30 (OR 1.10; 95%CI 1.07–1.12), and number of dosage increases between postoperative day 15 to 30 (OR 1.71, 95%CI 1.41–2.08). The strongest negative predictors were number of dosage decreases in the 30-day postoperative period. CONCLUSIONSWe evaluated several predictive models for postoperative long-term opioid use in a large cohort of patients with LBP or LEP who underwent surgery. A regression-based model with high sensitivity and AUC is provided online to screen patients for high risk of long-term opioid use based on preoperative risk factors and opioid prescription patterns in the first 30 days after surgery. It is hoped that this work will improve identification of patients at high risk of prolonged opioid use and enable early intervention and counseling.

PMS40 REAL-WORLD TREATMENT PATTERNS AND ECONOMIC BURDEN OF ROTATOR CUFF TEAR PATIENTS IN THE US

This study examined treatment characteristics and associated economic burden of Rotator cuff tears (RCT). Patients aged ≥18 years with ≥1 inpatient or ≥2 outpatient RCT diagnosis ≥30 days apart were identified in 1/1/2013-6/30/2017 using the IBM Watson Health MarketScan® Commercial database (index date=first observed RCT diagnosis). All patients had 1-year pre-index and post-index periods. Patient characteristics, all-cause costs, RCT-related costs (plan paid and patient out-of-pocket), healthcare resource utilization (HRU), and rotator cuff repairs (RCR) were reported by RCT type (partial or complete tears). Among 102,488 RCT patients identified, 45.7% were partial tear (46,856) and 54.3% were complete tear RCT (55,632). Partial were younger (56.3 years) than complete RCT (60 years). Complete RCT had higher rates of hypertension (49%), hypercholesterolemia (11%) and diabetes (19%). Physical therapy (82%), opioid (77%), and non-opioid medication (51.0%) were the most common conservative treatments. Post-index opioid use was significantly higher for complete (82%) compared to partial RCT (71%). About 30% of partial progressed to complete tear status with an average time of 79 days. About half of RCT patients had an RCR procedure (37% partial RCT, 61% complete RCT). Average time to first RCR was shorter for complete (46 days) than partial RCT (62.5 days). Among patients with 12-month post-RCR eligibility, around 6.1% partial and 6.4% of complete RCT had repeat surgery. Complete RCT patients had an average total baseline (within 12 months pre-index) costs of $17,096 and post-index costs of $32,110. Similarly, partial thickness patients had baseline costs of $16,385 and post-index costs of $27,017. Complete RCT patients had higher RCT-related post-index total cost compared to partial RCT ($9,183 vs. $7,283, p<0.0001). Despite almost all RCT patients seeking conservative treatment, half of RCT diagnosed patients require surgical treatment eventually. High opioid use, HRU and costs highlight the importance of efficiently managing patients with RCT diagnosis

PMH30 PREVALENCE AND FACTORS ASSOCIATED WITH NARCOTIC CONTROLLED SUBSTANCE USE AMONG PEOPLE WITH DEPRESSION AND ANXIETY: NHANES 2015-2016

Given the prevalence of anxiety (18.1%) and depression (6.7%) in US adults, and continual fight against opioid addiction, the purpose of the study was to examine the prevalence and other factors associated with narcotic controlled substance use among people with these disorders. The most recent 2015-2016 cycle of the National Health and Nutrition Examination Survey (NHANES) was used as the data source. NHANES captures cross-sectional survey data that is representative of the US civilian population. This study included adults at least 18 years of age, categorized for depression symptom severity using the Patient Health Questionnaire (PHQ-9). The use of prescribed opioids was assessed for each individual. Anxiety information was also identified via new survey questions implemented in this most recent cycle. Descriptive analysis and logistic regression of demographic, medical, and social characteristics were conducted using SAS 9.4. An odds ratio (OR) with 95% confidence interval was used a measure of association. A total of n=991 NHANES participants were included in this analysis. The prevalence of narcotic opioid for the NHANES population with depression was 10.49%. The odds of prescription narcotic opioid use were markedly higher among white participants and for older adults 40-59 (OR= 4.3 CI, 2.46 - 7.56) and ≥60 years (OR= 4.26 CI, 2.28 - 7.97). The odds higher in lower-income families (OR= 4.13 CI, 1.235 - 13.813), and in Medicare beneficiaries (OR= 5.414 CI, 2.867 - 10.224). The use of opioid prescriptions increased with increasing severity of depression symptoms; with moderately severe (OR= 4.074 CI, 2.273 - 7.301) and severe (OR= 3.754 CI, 1.801 - 7.825). The presence of anti-depressants was also associated with higher opioid use. As the healthcare field and patients adapt to the emerging opioid prescribing practices designed to curb the spread of opioid misuse, depression patients should not go unnoticed. Careful management of their needs is necessary.

Analgesic use after vaginal delivery in women with perineal lacerations: a retrospective cohort study

Objective: To evaluate opioid consumption among parturients with varying degrees of perineal lacerations.Methods: This was a retrospective analysis of women who delivered vaginally at our institution from 1 January 2014 to 12 April 2015. We collected information regarding the degree of perineal lacerations (no lacerations, first-/second-degree, third-/fourth-degree), analgesic consumption, and postpartum pain scores. The primary outcome was opioid use from 0–48 h postpartum. Univariate and multivariable regression analyses were performed to test for the association of laceration severity with opioid use.Results: We included 5598 women in the analysis; 1948 had no lacerations, 3434 had first-/second-degree lacerations, and 216 had third-/fourth-degree lacerations. In univariate analysis, parturients with third-/fourth-degree lacerations had significantly higher use of opioids within 48 h postpartum (53.2%) compared to women with no lacerations (30.03%) or first-/second-degree lacerations (28.6%) (p < .001). In the multivariable analysis, women with third-/fourth-degree lacerations had higher odds of opioid use than those without laceration [OR (95% CI) = 2.61 (1.75–3.85), p < .001]. In pairwise comparisons, those with third-/fourth-degree lacerations had higher odds of opioid use than those without lacerations [OR (95% CI) = 3.55 (2.20–5.74)], and those with first-/second-degree lacerations [OR (95% CI) = 2.15 (1.49–3.10)] (p < .001). Oxycodone equivalent consumption was significantly different among groups with a median (IQR) of 5.00 mg (0.00–27.50), 0.00 mg (0.00–5.00) and 0.00 mg (0.00–5.00) in women with third-/fourth-degree, first-/second-degree, and no lacerations, respectively, during the 0–48 h postpartum (p < .001).Conclusion: The use of opioids and opioid doses are higher in women with third-/fourth-degree perineal lacerations compared to those with first-/second-degree or no lacerations.

Opioid Consumption After Arthroscopic Meniscal Procedures and Anterior Cruciate Ligament Reconstruction.

Background:Procedure-specific opioid-prescribing guidelines have the potential to decrease the number of unused pills in the home without compromising patient satisfaction. However, there is a paucity of data on the minimum necessary quantity to prescribe for outpatient orthopaedic surgeries.Purpose:To prospectively record daily opioid use and pain levels after arthroscopic meniscal procedures and anterior cruciate ligament reconstruction (ACLR) at a single institution.Study Design:Case series; Level of evidence, 4.Methods:A total of 95 adult patients who underwent primary arthroscopic knee surgery (meniscectomy, repair, or ACLR) were enrolled. Patients with a history of opioid dependence were ineligible. Daily opioid consumption and Numeric Rating Scale pain scores were collected through an automated text-messaging platform starting on postoperative day 1 (POD1). At 6 weeks or at patient-reported cessation of opioid use, final survey questions were asked. Patients who failed to complete data collection were excluded. Opioid use was converted into “pills” (oxycodone 5-mg equivalents) to facilitate comparisons and clinical applications. Factors associated with high and low opioid use were compared.Results:Of the 95 patients enrolled, 71 (74.7%) were included in the final analysis. Of these, 40 (56.3%) underwent meniscal surgery and 31 (43.7%) underwent ACLR. After outpatient arthroscopic meniscectomy or repair, the total median postdischarge opioid use was 0.3 pills (oxycodone 5-mg equivalents), with 75% of patients consuming 3.3 or fewer pills (range, 0-19 pills). For ACLR, the median postdischarge consumption was 7 pills (75th percentile, 23.3 pills; range, 0-41 pills). Almost one-third of patients (32.3%) took no opioids after surgery (3 ACLR, 20 meniscus). All meniscus patients and 71% of ACLR patients ceased opioid consumption by postoperative day 7.Conclusion:Opioids may not be necessary in all patients, particularly after meniscal surgery and in comparison with ACLR. For patients requesting opioids for pain relief, reasonable prescription quantities are 5 oxycodone 5-mg pills after arthroscopic meniscal procedures and 20 5-mg pills after ACLR. Slowing the current opioid epidemic and preventing future crises is dependent on refining prescribing habits. Clinicians should strongly consider patient education regarding expected pain as well as pain management strategies.