Identifying the 'gray zone': Developing scalable methods to detect opioid misuse in veterans on long-term opioid therapy for pain.

Opioids can cause adverse cardiovascular effects (e.g., hypotension, arrhythmias), which can be concerning in individuals with pre-existing cardiovascular disease (CVD). Currently, little is known regarding the trends in opioid use among individuals with CVD. To evaluate the long-term trends of prescription opioids among adults with CVD in the United States. Using National Health and Nutrition Examination Survey data from 2001 to March 2020, adults ≥20 year old with ≥1 of the following CVDs - heart failure, coronary heart disease, angina, myocardial infarction, and stroke - were identified. Trends in the use of any, short-term (≤90 days), and long-term (>90 days) prescription opioids were evaluated. Subgroup analyses were conducted to test trends in any prescription opioid use by CVD types, pain-related comorbidities, and demographic/socioeconomic characteristics. Multivariable logistic regression, adjusted for age, was used to test the trends in 4-year examination periods. Among 6250 participants with CVD, no significant trends in the use of any prescription opioids were observed throughout the study period (9.4% in 2001-2004% to 11.8% in 2017-March 2020; P = 0.25). The prevalence of long-term prescription opioid use increased from 6.6% in 2001-2004% to 10.4% in 2017-March 2020, with a peak prevalence of 12.6% in 2013-2016 (P = 0.04). During the study period, an increase in the prevalence of any prescription opioid use was seen among individuals aged ≥65 years, from 7.5% in 2001-2004% to 11.3% in 2017-March 2020 (P = 0.006). Although overall prescription opioid use among participants with CVD remained relatively consistent between 2001 and March 2020, the use of long-term opioid prescriptions increased, possibly reflecting a growing burden of chronic pain in this population. Prescription opioid use also appeared to have increased among individuals aged ≥65 years, raising concerns due to their heightened risk of cardiovascular adverse effects from opioids.

Abstract Aim Despite strict regulation, Germany is among the countries with the highest per capita consumption of opioid analgesics. This explorative analysis aims to describe the probability of opioid discontinuation in relation to the duration of opioid prescription in a large population-based sample with long-term opioid prescriptions for chronic non-cancer pain (CNCP). Subject and methods Administrative claims data of a large nationwide statutory health insurance of patients with opioid prescriptions in two successive quarters were analyzed retrospectively. The selection period was from January 2018 to June 2019. The date of the first opioid prescription in the selection period marked the start of the 24-month observation period for each patient. Eligible categories of diagnoses appraised by the German guideline for long-term opioid therapy in chronic non-cancer pain were identified in inpatient and outpatient claims data. Results Inclusion criteria were met by 113,476 patients with long-term opioid prescriptions (75% female, mean age 72 years). Diagnoses in line with the German guideline were identified in 75% to 80% of patients. Half of the study population (49%) had received opioid prescriptions for at least 1 year prior to the observation period. The probability of opioid discontinuation decreased from 39% in patients with prior opioid treatment for less than 1 year to 10% for patients with prior opioid treatment in at least 1 year. Conclusion The results give important insights into patient structure and the probability of opioid discontinuation of patients with long-term opioid prescriptions for CNCP in Germany.

Despite being commonly prescribed to treat painful diabetic peripheral neuropathy (DPN), the impact on the brain of long-term opioid use as analgesia is unknown. The aim of this study was to determine the structural and functional brain alterations associated with prescription opioid use in a large cohort of people with painful DPN. A total of 82 patients with diabetes were enrolled: 57 with painful DPN (18 with long-term opioid prescription [O+ individuals] and 39 who were not prescribed opioids [O- individuals]) and a control group of 25 patients with diabetes but without DPN (no DPN) matched for age (± 2 years), sex and type of diabetes. All participants underwent detailed clinical/neurophysiological assessment and brain MRI at 3T, and a subset (14 in each group, n=42) also underwent resting-state functional MRI. O+ individuals had greater caudate volume (ANOVA, p=0.03) compared with O- individuals (p=0.03) and those with no DPN (p=0.01). Functional connectivity was lower between the caudate and thalamus (r β = -0.24, seed-level correction -3.9, pFDR ≤0.05) in O+ individuals compared to those with no DPN. Moreover, seed-to-voxel analysis using caudate as the seed showed a significantly lower functional connectivity in O+ individuals compared with O- individuals in a cluster encompassing the superior frontal gyri bilaterally. We demonstrate that disruption of dopaminergic pathways occurs within the brain when opioids are used for analgesic purposes for painful DPN, which may reflect alterations in reward systems. This study has important clinical implications, as the measures of dopaminergic pathways found in this study may represent neuroimaging biomarkers that could be used to diagnose and monitor the negative consequences of prescription opioid use.

Opioids are essential medicines for pain management; however, long-term use is associated with negative outcomes, including addiction. The aim of the study was to analyze the risk of long-term use after an initial opioid prescription and examine associated sociodemographic and health care-related risk factors. We identified a strictly defined, five-year opioid-naïve population of adults aged 18-64 years who received an initial opioid prescription between 2016 and 2020 in Swedish national registers. We modeled the association between individual characteristics and odds of long-term ( > 3 months) versus short-term ( ≤ 3 months) use, and odds of different durations of use ( > 3-6, >6-12, and >12 months) using logistic regression analyses. Of 754,982 opioid-naïve individuals with an initial opioid prescription, 8.1% use opioids long-term. Individuals treated for a recent external injury have lower odds of long-term opioid use (e.g., >12 vs ≤3 months: OR 0.55, 95% CI 0.52-0.59), whereas those who initiated treatment in primary care have higher odds (e.g., >12 vs ≤3 months: OR 3.02, 95% CI 2.90-3.14). Individuals with a history of substance use disorders and greater use of psycholeptic drugs have higher odds of long-term use. Sociodemographic factors, including older age, lower education level, and not cohabiting are also associated with longer durations of use. Of opioid-naïve individuals, 8.1% develop long-term prescription opioid use, with higher odds among individuals with psychiatric history and whose opioid treatment initiated in primary care. Careful evaluation of patient health and regular follow-up are essential to reduce the risk of long-term opioid use.

There has been a steady decline in the national opioid-dispensing rate in recent years. However, emerging evidence that suggests that abrupt discontinuation of opioids for pain may increase overdose risk. The authors examined associations between prescribed opioid tapering and short-term risk of overdose among adults who have received a new long-term high-dose opioid prescription. This cohort study included adults (aged ≥18 years) without cancer who were newly prescribed a long-term high-dose opioid, that is, daily dose ≥50 morphine milligram equivalents for ≥183 days, between 2013 and 2018 in Kaiser Permanente Southern California. Opioid tapering within the evaluation period (3 months after being prescribed long-term high-dose opioid) was defined as a reduction ≥10% in monthly morphine milligram equivalents for at least 2 consecutive months compared with baseline morphine milligram equivalents. The association of opioid tapering with incident opioid overdose within 12 months was examined separately using multivariable Cox proportional hazard models with inverse probability of treatment weight. Sensitivity analyses were performed to differentiate the association by tapering rates. Among 12,866 eligible individuals, 7,372 (57.3%) initiated tapering within 3 months. Seventy-five patients had a documented opioid overdose event within 12 months during follow-up, resulting in an incidence rate of 0.022 and 0.013 event per 1,000 person-years, respectively, among the nontapered and tapered cohorts. Tapering within the evaluation period was associated with a 0.48 (hazard ratio=0.52; 95% CI=0.33, 0.82) reduction in risk of overdose in the subsequent 12 months. Sensitivity analyses suggested that a tapering rate of 20%-40% reduction monthly was associated with lower risk. Among patients newly prescribed long-term high-dose opioids, initiating tapering within 3 months was shown to be associated with reduced short-term risk of opioid overdose. However, more studies are needed for further confirmation.

Study DesignA retrospective cohort study.PurposeTo evaluate the association between preoperative opioid use and discharge disposition following major spine surgery and between discharge disposition and opioid availability through 1 year postoperatively.Overview of LiteraturePreoperative opioid use is prevalent in spine surgery and is associated with larger postoperative opioid consumption, longer hospitalizations, increased healthcare expenses, and greater risk of surgical revision. However, whether preoperative opioid use is associated with discharge disposition following major spine surgery, which may serve as an indicator of postoperative functional recovery, remains unclear.MethodsThis retrospective population-based cohort study incorporated comprehensive prescription opioid information for 2223 adults (age ≥18 years) undergoing spine surgery in Olmsted County, Minnesota, between January 1, 2005, and December 31, 2016. Multivariable models were employed to assess the relationships among preoperative opioid exposures, postoperative opioid exposures, and discharge disposition (home, inpatient rehabilitation facility [IRF], and skilled nursing facility [SNF]).ResultsA total of 2,223 adults were included with the following preoperative opioid availability: none (778 [35.0%]), short term (1,118 [50.3%]), episodic (227 [10.2%]), and long term (100 [4.5%]). Discharge dispositions were home (1,984 [89.2%]), IRF (94 [4.2%]), and SNF (145 [6.5%]). Compared with patients with no preoperative opioid availability, those with short-term or episodic opioid availability are less likely to be discharged to an IRF (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.36–0.87; p=0.010). Patients with long-term opioid availability had significantly increased odds of SNF discharge (OR, 2.93; 95% CI, 1.39–6.17; p=0.005). At 1-year follow-up, patients discharged to IRF had an increased likelihood of long-term postoperative opioid availability compared with those discharged home (OR, 12.49; 95% CI, 4.84–32.24; p<0.001).ConclusionsPreoperative opioid prescribing was associated with post-hospitalization discharge disposition, which in turn was associated with opioid prescribing patterns 1 year postoperatively. Assessing opioid prescribing trends preoperatively may guide discussions regarding anticipated discharge disposition following spine surgery.

There is wide variation in opioid prescribing practices, including opioid quantity and risk mitigation strategies (RMS). Urine drug tests (UDT) are often used as a RMS for patients prescribed opioids. There is a lack of standardized recommendations for these tests. We aim to evaluate differences in prescribing practices, including opioid prescriptions and UDT as an RMS, among patients with multiple opioid prescriptions. A retrospective analysis of a national outpatient database of long-term adult opioid prescriptions (≥ 3 prescriptions over a period of at least 120-days) in the United States. Demographics, abuse history, morphine milligram equivalents (MME), UDT, and frequency were variables of interest. 96,994 met the inclusion criteria. Hispanic patients were prescribed less MME/day than non-Hispanics. Examining patients prescribed ≥ 50 MME/day, the highest rates were in American Indian/Alaskan native (8.4%) and White patients (7.5%). At least one UDT was performed in 18,203 (18.8%) patients. When categorized by race, UDTs showed that 25.8% of American Indian/Alaska native, 22.7% of Black patients, 19.2% of multiple races, 18.0% of White patients, 13.5% of Hawaiian/Pacific Islanders, and 12.7% of Asian patients underwent UDTs (p < 0.001). Among the category of ≥ 7 UDTs, Black patients (1.3%) received the most. Upon regression modeling, females (OR 0.94) and uninsured patients (OR 0.66) were less likely to undergo UDT. Among MME categories, patients prescribed 75-99 MME/day had the highest likelihood of UDT (OR 2.4). Those with opioid use disorder (OR 2.64) and tobacco use (OR 1.083) were tested more frequently. When examining race, American Indian/Alaskan natives (OR 1.36), Black patients (OR 1.36), and multiple races (OR 1.245) were more likely to undergo UDT than White patients (reference). There is variation in opioid prescribing practices, including opioid quantity and UDT. White patients receive more opioids but less UDT than other populations. Improvements are needed to ensure universal opioid prescribing practices.

The number of unintentional deaths involving opioid and/or benzodiazepine use continues to increase in Australia. This study examined patterns of concurrent prescribing of opioids and benzodiazepines/Z-drugs (BZDs) for long-term use in Australian general practice. A cross-sectional analysis was undertaken using MedicineInsight, a national database of de-identified general practice electronic health records. We estimated the proportion of patients (per 1000, ‰) in 2017 receiving concurrent prescriptions for opioid and BZD medications for long-term use (≥ 3 prescriptions within 90 days). Poisson regression models were used to estimate the marginal adjusted prevalence (adjP) and adjusted prevalence ratios (adjPR) were used to compare concurrent long-term prescribing according to sociodemographic characteristics, rurality, smoking status, and diagnosis of mental health or musculoskeletal conditions. The sample included 1,207,671 individuals (41.3% males; mean age 50.6 ± 18.6 years) regularly attending 544 general practices. The prevalence of concurrent long-term opioid and BZD prescribing was 7.0‰, and the median duration of prescribing overlap was 611 days (p25-p75 348-952). The prevalence was higher for patients aged over 65 years (adjPR = 3.62 95% CI 3.30, 3.98), females (adjPR = 1.33 95% CI 1.27, 1.39), those living in more disadvantaged (adjPR = 1.70 95% CI 1.49, 1.93) or rural/remote areas (adjPR = 1.13 95% CI 1.00, 1.28), smokers (adjPR = 4.10 95% CI 3.87, 4.35), and those with mental health (adjPR = 3.23; 95% CI 2.83, 3.69) or musculoskeletal conditions (adjPR = 2.74; 95% CI 2.47, 3.04). In patients with both mental health and musculoskeletal conditions, the prevalence was 32.1‰. Interventions to reduce concurrent long-term prescribing could be targeted to the identified vulnerable groups.

General opioid prescribing has decreased in response to practice guidelines and policy changes, but information on recent practices in initial opioid prescribing is needed to support interventions to reduce the risk of long-term opioid prescription use. This cross-sectional study examined Military Health System data between 1 October 2015 and 30 September 2021 to explore initial opioid prescriptions and prescribing practices among providers serving 1.66 million US service members. We compared the characteristics of a subgroup (n=372 960) receiving an initial opioid within 7-24 months after study entry with those of the sample as a whole. We described characteristics of initial opioid prescriptions, including healthcare encounters associated with those prescriptions, prescriber characteristics and opioid prescribing practices. The analytic sample was composed of 1 666 019 service members, 372 960 of whom filled an initial opioid prescription 7-24 months after study entry. The analytic sample was 83% assigned male; 58% white, non-Hispanic, 16% black, non-Hispanic and 15% Hispanic; and had a mean age of 27 (8.02). Initial opioid fills had a median days' supply of four (IQR 3.0-5.0) and milligram morphine equivalents (MME) of 30 (IQR 20-50). 10% of prescribers wrote the majority (64%) of initial opioid fills, representing 67% of total initial opioid MME. Dental encounters were associated with 38% of initial opioid fills, and 19% of fills were associated with musculoskeletal conditions. Dentists were associated with 32% of total initial opioid fills and 25% of total initial opioid MME. During recent years in the Military Health System, dental care was an important driver of initial opioid receipt among a relatively young population with full dental coverage. Similar populations may benefit from interventions that support dental providers in maintaining within-guideline prescribing practices.

BackgroundAlthough opioids are effective for cancer pain management, long-term use may result in adverse effects which are understudied among patients with metastatic disease.ObjectivesTo describe long-term opioid prescribing among patients with...

Research is needed to measure the effects of shared decision-making (SDM) on discontinuation of opioid therapy for chronic pain. Target trial emulation. National pain research registry from September 2016 to January 2024. A total of 328 patients currently using opioid therapy for chronic low back pain at baseline, including 164 patients each in greater and lesser SDM groups matched on propensity scores. SDM was measured with the Communication Behavior Questionnaire. Primary outcomes involving discontinuation of opioid therapy and opioid prescribing frequency and secondary outcomes of pain, function, and health-related quality of life were measured over 12 months. The mean (SD) age of patients was 56.1 (SD, 11.1) years and 239 (72.9%) were female. During 1178 quarterly encounters, greater SDM was associated with less frequent discontinuation of opioid therapy 3 months postbaseline (RR, 0.56; 95% CI, 0.37-0.86; P = .006) and more frequent opioid prescribing 3 to 12 months postbaseline (RR, 1.24; 95% CI, 1.11-1.38: P < .001). Although greater SDM was associated with worse physical function, and opioid therapy was associated with greater back-related disability and worse physical function, these results were not clinically important. SDM x opioid therapy interaction effects were not observed, indicating that more frequent use of opioid therapy with SDM did not yield better outcomes. SDM was associated with less frequent short-term discontinuation of opioid therapy and more frequent long-term opioid prescribing that was not associated with better outcomes. Thus, SDM is necessary but insufficient to improve opioid prescribing for patients with chronic pain.

IntroductionChronic pain is prevalent among older adults with Alzheimer’s disease (AD) and Alzheimer’s disease-related dementias (ADRD). Memantine and acetylcholinesterase inhibitors (ACHEI; donepezil, rivastigmine, and galantamine) are approved for the treatment of dementia symptoms and may also have analgesic properties. However, findings on the clinical utility of these dementia medications for chronic pain treatment are mixed, and little is known about differences in the use of pain medication according to whether an older adult with AD/ADRD is using dementia medications.MethodsWe selected a 20% national sample of Medicare enrollees with a diagnosis of AD/ADRD and chronic pain in 2020. We calculated the odds of having any pain management prescription (opioids, serotonin and norepinephrine reuptake, gapapentinoids, or non-steroidal anti-inflammatory drugs), having an opioid prescription, and having a long-term (≥ 90 days) opioid prescription, by dementia medication (none, memantine, ACHEI, or memantine and ACHEI).ResultsAmong 103,564 patients, 5.5% received a memantine prescription, 14.4% received an ACHEI prescription, and 8.6% received a prescription for both. Over 70% of all patients had a pain management prescription. The percentage of patients who had an opioid prescription ranged from 54.5% for those without a dementia medication prescription to 44.0% for those with a prescription for both memantine and ACHEI. Similarly, the percentage of patients who had a long-term opioid prescription was highest for those without a dementia medication prescription (12.2%) and lowest for those with a prescription for both memantine and ACHEI (8.8%). Having a prescription for memantine only was associated with lower odds of any pain management prescription (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.88–1.00; p < 0.05). Having a prescription for either memantine (OR: 0.79; 95% CI 0.75–0.84), ACHEI (OR: 0.85; 95% CI 0.82–0.89), or both (OR: 0.75; 95% CI 0.72–0.79) was associated with lower odds of having an opioid prescription (p < 0.05). Lastly, having a prescription for either memantine (OR: 0.85; 95% CI 0.77–0.94), ACHEI (OR: 0.92; 95% CI 0.86–0.98), or both (OR: 0.83; 95% CI 0.77–0.90) was associated with lower odds of having a long-term opioid prescription.DiscussionOlder adults with co-occurring AD/ADRD and chronic pain who were on dementia medications had lower odds of being prescribed opioid analgesics. Memantine and ACHEIs should be explored as potential opioid-sparing medications for older adults with AD/ADRD, given their relatively safe profiles. Future studies are needed to examine repurposing dementia medications for pain treatment.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40266-025-01181-w.

Opioid misuse is increasingly recognized as a relevant problem among patients with cancer. However, the applicability of these concerns for patients with metastatic disease is complicated by shorter prognoses and greater symptom burden. This study aimed to investigate whether nonmedical opioid use (NMOU) was identified as contributing to opioid-related healthcare encounters among patients with metastatic cancer receiving long-term prescribing. The study included patients with stage IV cancer diagnosed from 2004-2017 in Alberta, Canada who 1) received long-term opioid prescribing and 2) experienced ≥ 1 hospitalization or emergency department visit relating to opioid overdose or use disorder. Records from visits to cancer centres and opioid-related hospital encounters were reviewed to identify any documentation of NMOU. Patient characteristics were compared between those with and without documented NMOU. Charts of 46 patients were reviewed. Although NMOU contributed to opioid-related encounters, these events were often related to poorly controlled pain, declining functional status, and disease progression. NMOU behaviors were documented for 16 (35%) patients. The most common NMOU behaviour was overuse of prescribed medications, which was documented for 12 patients. For 7 patients, there were indications of use of opioids for psychological coping, including 3 encounters caused by intentional overdoses with suicidal intent. Patients with NMOU were significantly more likely to have a history of substance use and limited social support. Approximately 1-in-3 patients experiencing opioid-related hospitalizations/emergency department visits had indications of NMOU. Further psychosocial care and interdisciplinary pain management are warranted to improve safe prescribing for these patients.

HintergrundDer Stellenwert der Opioide bei nichttumorbedingten Schmerzen wird kontrovers diskutiert. Aus Deutschland fehlen aktuelle Daten zur Opioidverordnung bei nichttumorbedingtem Schmerz.Ziel der ArbeitDaten zur Prävalenz von kurz- und langfristigen Opioidverordnungen, verschriebenen Wirkstoffen, Komedikation, verschreibenden Fachgruppen und demografischen und klinischen Charakteristika der Patienten.Material und MethodenRetrospektive Analyse von Abrechnungsdaten erwachsener BARMER-Versicherter ohne Hinweis auf einen bösartigen Tumor für das Jahr 2021 (n = 6.771.075) sowie Versicherter mit Neubeginn einer Opioidtherapie in 2019 (n = 142.598).Ergebnisse5,7 % der Versicherten ohne Krebsdiagnose erhielten in 2021 mindestens eine Opioidverordnung, 1,9 % eine Langzeittherapie. Tilidin und Tramadol waren die am häufigsten verordneten Opioide in Kurz- und Langzeittherapie. Frauen erhielten häufiger Opioide als Männer. Die Verordnungshäufigkeit stieg mit dem Alter deutlich an. In 2021 erhielten 22,5 % der Versicherten mit Langzeitopioidtherapie eine Komedikation mit Pregabalin und/oder Gabapentin, 37,5 % mit einem Antidepressivum und 58,1 % mit Metamizol und/oder nichtsteroidale Antirheumatika (NSAR). Erstverordnungen erfolgten zu 59,5 % durch Hausärzte. Im ersten Therapiejahr waren bei Personen mit Langzeitopioidtherapie im Mittel 2,1 Praxen an der Schmerzmittelverordnung beteiligt, 13 verschiedene chronische Krankheiten wurden dokumentiert.DiskussionDie Opioidtherapie nichttumorbedingter Schmerzen findet überwiegend im hausärztlichen Bereich bei älteren, multimorbiden Patienten statt. Die Indikationsstellung erfordert eine gemeinsame Entscheidungsfindung mit Patientinnen und Patienten und gegebenenfalls ihren Angehörigen sowie die Überprüfung möglicher Arzneimittelinteraktionen.Graphic abstractZusatzmaterial onlineDie Online-Version dieses Beitrags (10.1007/s00482-024-00852-8) enthält weitere Tabellen.

200 Background: Many patients with metastatic cancer experience cancer-related pain which is commonly managed using opioids. Although opioids are an effective tool for cancer pain management, their use can result in adverse effects which may be related to long-term use and are understudied in this population. Therefore, we aimed to describe long-term opioid prescribing (LTOP) practices among patients with metastatic cancer and investigate the incidence of opioid-related hospitalizations and emergency department (ED) visits among recipients of long-term prescribing. Methods: This retrospective cohort study used population-based data from Alberta, Canada to identify patients diagnosed with stage IV cancers between 2004-2017 who had at least 1-year of follow-up and were opioid naïve at diagnosis. LTOP was defined as receipt of a ≥90-day supply of opioids with less than a 30-day gap in supply within a 180-day period. Prescribing practices were characterized according to timing (early vs. end-of-life [EoL] onset), morphine equivalent dose, duration, and concurrent medication use. The EoL phase of disease was defined as the year preceding death. The incidence rate of opioid-related encounters was compared between different characteristics of LTOP. Results: The study included a total of 10927 patients, 2521 (23%) of whom received long-term opioid prescribing after diagnosis. LTOP became more common as patients approached EoL, with most patients (53%) having LTOP initiated only within their last year of life. 85 patients (3.4%) experienced an opioid-related hospitalization or ED visit after initiation of LTOP, with an incidence rate of 2.36 (95% CI 1.92, 2.86) encounters per 100 person-years. Higher opioid dosage and concurrent prescribing of anxiolytics, benzodiazepines, antidepressants, and neuroleptic medications were significantly associated with a higher incidence of opioid-related encounters. Conclusions: Long-term opioid prescribing is commonly experienced by patients living with metastatic cancer as a chronic disease. The concurrent use of psychoactive drugs during LTOP was associated with experiencing opioid-related hospitalizations/ED visits.

Persistent and chronic opioid use after ambulatory surgery in US veterans (2011–2018)

Pain is important for patients with kidney failure, but opioid medication prescriptions are associated with morbidity and mortality. The Centers for Disease Control and Prevention issued opioid prescription guidelines in 2016 and 2022, associated with dramatically decreased prescription rates in the United States. It is critical to know if nationwide opioid prescription rates for patients with kidney failure have decreased. We analyzed the USRDS database from 2011 to 2020 to describe trends in the proportion of ESKD patients who received one or more, or long-term opioid prescriptions, examined factors associated with long-term opioid prescriptions, and evaluated associations of all-cause death with short-term or long-term opioid prescriptions. From 2011-2022, the percentage of patients with kidney failure (dialysis and kidney transplant) who received at least one or more, or who had received long-term opioid medication prescriptions decreased steadily, from 60% to 42%, and from 23% to 13%, respectively (both P for trend <0.001). The largest reductions in prescription rates were for hydrocodone and oxycodone. Similar trends existed for dialysis and kidney transplant patients. Women, the poor and those in rural settings were more likely to receive long-term opioid prescriptions. Prescription rates were highest in White patients and those 45 to 64 years old. Short-term and long-term opioid medication prescriptions were associated with higher mortality in both dialysis and kidney transplant patients. ESKD patients' opioid prescription rates decreased between 2011 and 2020. Higher mortality risk was associated with both short-term and long-term opioid prescriptions. Mortality risk was monotonically associated with morphine milligram equivalents in patients with kidney failure who received long-term opioid prescriptions.

To describe the impact of a standardized opioid prescribing intervention when implemented in three family medicine (FM) residency training - clinics-environments that face operational challenges including regular resident turnover. We performed a retrospective cohort study to compare patterns of long-term opioid prescribing between residency and nonresidency clinics. This study took place within a large, academic, health system. Three FM residency clinics were compared with three nonresidency FM clinics. A standardized opioid prescribing process was developed and implemented within the FM residency clinics. Nonresidency clinics used an independent process and were not exposed to the intervention. Descriptive comparisons were performed for treatment and control clinics' opioid prescribing from 2015 to 2018. The primary outcome was a patient's annual opioid exposure supplied from these select clinics. We also examine coprescribing with high-risk medications that potentiate the overdose risk of opioid prescriptions. Difference-in-difference modeling was used to control for clinic-level variation in practice. Statistically significant decreases were observed in both residency and nonresidency clinics for the mean number of opioid prescriptions and the mean daily morphine milligram equivalent. These decreases were comparable between the residency and nonresidency clinics. Residency clinics face unique challenges and require innovative solutions to keep up with best practices in opioid prescribing. Our residency clinics' implementation of a standardized intervention, including electronic health record integration, standardized processes, and metric management, suggests steps that may be valuable in achieving outcomes comparable to nonresidency clinics in large health systems.

Opioids are known to cause respiratory depression, aspiration, and to suppress the immune system. This study aimed to investigate the relationship between short- and long-term opioid use and the occurrence and clinical outcomes of pneumonia in South Korea. The data for this population-based retrospective cohort analysis were obtained from the South Korean National Health Insurance Service. The opioid user group consisted of those prescribed opioids in 2016, while the non-user group, who did not receive opioid prescriptions that year, was selected using a 1:1 stratified random sampling method. The opioid users were categorized into short-term (1-89 d) and long-term (≥90 d) users. The primary end point was pneumonia incidence from January 1, 2017-December 31, 2021, with secondary end points including pneumonia-related hospitalizations and mortality rates during the study period. In total, 4,556,606 adults were enrolled (opioid group, 2,070,039). Opioid users had a 3% higher risk of pneumonia and an 11% higher risk of pneumonia requiring hospitalization compared to non-users. Short-term users had a 3% higher risk of pneumonia, and long-term users had a 4% higher risk compared to non-users (P < .001). Additionally, short-term users had an 8% higher risk of hospital-treated pneumonia, and long-term users had a 17% higher risk compared to non-users (P < .001). Both short- and long-term opioid prescriptions were associated with higher incidences of pneumonia and hospital-treated pneumonia. In addition, long-term opioid prescriptions were linked to higher mortality rates due to pneumonia.