Morphine Milligram Equivalents Dose Research Articles

Prescription trends of opioid and non-opioid controlled prescription adjunctive analgesics prior to and after cervical spinal surgery: a retrospective cohort study.

Cervical spine surgery (CSS) may be needed in those with refractory pain or neurologic deficits to improve outcomes in patients with cervical spine disease. However, consensus varies in the literature on the effect of surgery on opioid use. The objectives of this study were to analyze prescription rates of multiple controlled-substances before and after CSS and distinguish factors that may have contributed to opioid use after surgery. This is a retrospective cohort study analyzing prescription trends of various controlled substances in 632 patients who underwent CSS from 2019 to 2021. Opioids have the largest rise in prescriptions at 3- and 6-month time points after CSS. A significant association (p < 0.001) was found between opioid use one year prior to and one year after CSS. Exposure to opioids prior to surgery (OR 2.77, 95% CI 1.43, 5.51, p = 0.003) and higher morphine milligram equivalent (MME) dose (OR 1.02, 95% CI 1.01, 1.04, p = 0.012) were found to be associated to opioid use after surgery. Significantly more females were prescribed controlled substances (p = 0002). Higher MME dose and opioid exposure prior to surgery are important factors in predicting post-surgical opioid use.

The Relationship Between Limited English Proficiency and Discharge Opioid Prescription Among Patients Undergoing Operation

INTRODUCTION: Barriers to effective communication may negatively impact pain assessment and the decision to prescribe opioids. In this study, we examine the relationship between limited English proficiency (LEP) and postoperative opioid prescribing. METHODS: This is a cross-sectional study of patients undergoing operation across a large healthcare delivery system between 2016 and 2020. Discharge opioid prescription was converted to morphine milligram equivalents (MME). Odds of being prescribed an MME dose below the 25th percentile and above the 75th percentile were compared between English proficient (EP) and LEP patients using multivariable logistic regression. RESULTS: Among 89,383 patients included in this study (mean age 52.13 years, 51% female), 7.4% had LEP; 21.6% (95% CI 21.3% to 21.8%) of EP patients and 28.5% (95% CI 27.4% to 29.6%) of LEP patients were not prescribed opioids. Among those who had an opioid prescription, the median (interquartile range [IQR]) MME was lower in LEP compared with EP patients (150 [75 to 225] vs 180 [96 to 315]). Median MME at discharge varied across surgical specialties (Fig. 1). Patients with LEP had higher odds of being prescribed lowest quartile MME (odds ratio [OR] 1.32, 95% CI 1.21 to 1.43) and lower odds of being prescribed highest quartile MME (OR 0.66, 95% CI 0.59 to 0.73) compared with EP patients after adjustment for clinical characteristics and surgical specialty.CONCLUSION: No opioid prescribing and less opioid prescribing occurred more often in LEP patients. If these differences result in inadequate pain management, this may be an opportunity for performance improvement. Given that larger MME prescriptions can be problematic, the clinical impact of these differences remains to be determined.

Opioid-induced respiratory depression and risk factors in a tertiary hospital: A retrospective study

BackgroundOpioids are potent analgesics used for the treatment of moderate to severe acute and chronic cancer and non-cancer pain. However, opioid usage may be limited by negative side effects, such as potentially life-threatening respiratory depression. ObjectivesThe aim of our study is to investigate the prevalence of opioid-induced respiratory depression (OIRD) and its predictors at King Abdulaziz Medical City in Jeddah (KAMC-JD). MethodThis is a retrospective cross-sectional (chart review) study conducted from January 1, 2016, to December 31, 2020. ResultsA total of 15,753 patients received opioids during admission to KAMC-JD, and only 144 (0.915%) of them received naloxone from January 1, 2016 to December 31, 2020. Only 91 patients (0.57%) developed opioid-induced respiratory depression (OIRD), which was more frequently reported among young and middle-aged adults. OIRD was significantly associated with receiving a daily morphine milligram equivalent (MME) dose of ≥150 MME and with having a low urea concentration at the baseline and at admission under surgery. Also, fentanyl use remained a significant risk factor for OIRD. ConclusionIn conclusion, monitoring patient receiving opioids with a daily MME dose of ≥150 MME, prescribed Fentanyl, low urea concentration at the baseline, and patients’ admissions to the surgery department may mitigate the risk of developing OIRD.

Race, pain, and opioids among patients with chronic pain in a safety-net health system

BackgroundRecent changes in opioid prescribing practices in the US may exacerbate disparities in opioid access among Black compared to White patients. MethodsTo evaluate racial disparities in opioid prescribing and stewardship, we used baseline data collected from 2017 to 2019 for a longitudinal cohort of patients with chronic non-cancer pain and a history of illicit substance use. Sociodemographic characteristics, pain, psychological distress, substance use, and opioid prescription practices were compared between Black and White participants. We conducted multivariable logistic regression with race as the outcome. We also compared yellow flag events (opioid-related emergency department visits, illicit substances on urine drug screens, provider-documentation of concerning behaviors) by race. ResultsOver half of participants analyzed were Black (57%) and the remainder White (43%). Participants with worse average pain in the past three months (adjusted odds ratio [AOR]:1.29, 95%CI:1.08−1.55, p = 0.006) had higher odds of being Black. Past-year injection drug use (AOR:0.39, 95%CI:0.16−0.94, p = 0.04) and a higher past-year maximum opioid dose (AOR per 10 morphine milligram equivalents (MME):0.99, 95%CI:0.98−1.00, p = 0.006) were associated with lower odds of being Black. We found no differences by race in the use of opioid stewardship measures or discontinuation of opioids based on yellow flag events. ConclusionLower past-year maximum MME dose, despite higher average pain and less injection drug use, may represent bias away from prescribing opioids for chronic pain among Black patients. This could be due to unmeasured implicit provider bias or patient-level factors (e.g., utilizing non-opioid pain coping strategies or being less likely to request additional opioids).

163 Impact of a standardized post-cesarean analgesia regimen on postpartum opioid use

To determine if implementation of a standardized postoperative analgesic regimen decreases opioid use following cesarean birth. A standardized postoperative analgesia protocol was implemented in June 2018. It included scheduled acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) with opioids for breakthrough pain. There was no prior standardized protocol. A before-and-after study design was used to compare oral morphine milligram equivalents (MME) for nine months prior to and after this protocol was implemented, excluding the two month period of protocol rollout. Women with opioid use disorder or postoperative intubation were excluded. The primary outcome was the cumulative MME used in the first 72 hours postoperatively. Total MME dose at 12, 24, and 48 hours were also compared. Of 2340 women who underwent cesarean birth during the study period (7/1/17 – 4/30/19), 2001 women met inclusion criteria (914 before 4/10/18 (pre-protocol) and 1087 after 6/17/18 (post-protocol)). Baseline characteristics of the two groups were similar, including maternal body mass index (BMI), planned versus unplanned cesarean birth, and type of intraoperative anesthesia used. The cumulative opioid dose in the first 72 hours postoperatively was 216.3+/-84.3 MME prior to implementation compared to 171.5+/-91.5 MME following implementation (p<0.001). The average cumulative MME use was higher in the pre-protocol group compared to post-protocol at all time periods: 12 hours (57.3+/-23.8 vs 48.6+/-26.2 MME, p<0.001), 24 hours (98.1+/-34.1 vs 82.1+/-38.8 MME, p<0.001), and 48 hours (165.8+/-58.3 vs 134.9+/-66.2 MME, p<0.001). The average pain scores were lower in the pre-protocol group (3 vs 3.3, p<0.001). Scheduled administration of acetaminophen and NSAIDs following cesarean birth significantly decreased the cumulative dose of opioids used in the first 72 hours postoperatively by 20.7%. While the impact of this change is less than a full enhanced recovery after surgery protocol, this simple change resulted in an MME decrease that equates to 5-6 less doses of oral opioids.

Retrospective Chart Review of Advanced Practice Pharmacist Prescribing of Controlled Substances for Pain Management at the Harry S. Truman Memorial Veterans' Hospital.

The US Department of Health and Human Services' 5-point strategy to combat the opioid overdose public health crisis includes improved pain management. There is a shortage of adequately trained health care providers in pain management. Advanced practice pharmacists may be able to help fill that void. The objective of this project was to identify the impact of an advanced practice pharmacist with controlled substance prescriptive authority on morphine milligram equivalent dose (MME) and compliance with opioid risk mitigation. In March 2020, a single-site retrospective chart review was conducted of patients who were prescribed controlled substances from July 1, 2018 to January 31, 2020. Patients received care through the outpatient Pharmacy Pain Clinic in-person or via telephone who were enrolled at the Harry S. Truman Memorial Veterans' Hospital in Columbia, Missouri, or associated outlying outpatient clinics. Patients were included if they were referred to the Pharmacy Pain Clinic and prescribed a Schedule II or III opioid medication. A 2-sided t test was conducted to compare MME, and a Fisher exact test was used to compare adherence to opioid risk mitigation. Patients seen in Pharmacy Pain Clinic had a statistically significant reduction in MME from consult (93 MME) to discharge (31 MME) (P < .01). There was also a statistically significant (P < .01) improvement in use of opioid risk mitigation strategies, including urine drug screen, informed consent, naloxone, prescription drug monitoring program checks, and stratification tool for opioid risk mitigation dashboard reviews. An advanced practice pharmacist with controlled substance prescriptive authority improved patient care with demonstrated statistically significant differences in MME and adherence with opioid risk mitigation from consult to discharge. Health care teams should look to add advanced practice pharmacists to their team as medication experts to deliver comprehensive medication management, which can include controlled substance prescribing and management.

Clinical Presentation and Outcomes of Opioid-Induced Adrenal Insufficiency

Opioid-induced adrenal insufficiency (OIAI) may develop in patients treated with chronic opioids due to suppression of the hypothalamic-pituitary-adrenal axis. Our objective was to describe the clinical manifestations, biochemical presentation, and clinical course of OIAI. A retrospective study of adults diagnosed with OIAI between 2006 and 2018 at an academic center. Opioid daily dose was converted into morphine milligram equivalents (MMEs). Forty patients (women, n = 29 &lsqb;73%]) taking chronic opioids at a daily median MME dose of 105 (60 to 200) mg and median duration of 60 (3 to 360) months were diagnosed with OIAI. Patients reported fatigue (n = 29, 73%), musculoskeletal pain (n = 21, 53%), and weight loss (n = 17, 53%) for a median of 12 (range, 1 to 132) months prior to diagnosis, and only 7.5% (n = 3) of patients were identified with OIAI through case detection. Biochemical diagnosis of OIAI was based on (1) low morning cortisol, baseline adrenocorticotropic hormone and/or dehydroepiandrosterone sulfate in 59% (n = 26) of patients or (2) abnormal cosyntropin stimulation test in 41% (n = 14) of patients. With glucocorticoid replacement, 16/23 (70%) patients with available follow-up experienced improvement in symptoms. Opioids were tapered or discontinued in 15 patients, of whom 10 were followed for adrenal function and of which 7 (70%) recovered from OIAI. Minimum daily MME in patients diagnosed with OIAI was 60 mg. OIAI causes significant morbidity, and recognition requires a high level of clinical suspicion. Appropriate glucocorticoid treatment led to improvement of symptoms in 70%. Resolution of OIAI occurred following opioid cessation or reduction.

257. Persistent opioid use and resource utilization in spine surgery

BACKGROUND CONTEXT Postoperative pain control commonly involves opioid use. From 2004 to 2015, there was a significant increase in the rate of spine surgery in the US, which raised concerns about the increase in persistent use of opioid drugs after spine surgery. PURPOSE The objectives of this study were to assess the influence of opioid use during spine surgery on post-surgery opioid use and impact of health care resource utilization. STUDY DESIGN/SETTING A retrospective cohort analysis was performed using deidentified administrative data and electronic health records from the University of Utah Health system. PATIENT SAMPLE Patients undergoing spine surgery in the hospital from January 2015 to June 2018 were included. OUTCOME MEASURES The primary outcome of this study was persistent opioid use defined by (1) opioid prescription within 30 days after the index discharge followed by opioid prescription between 31 – 180 days after the index discharge, and (2) opioid prescription within 90 days after the index discharge followed by opioid prescription(s) between 91 – 180 days. Secondary outcomes of this study were the proportion of patients reporting opioid-related adverse events (ORADE) and medical resource utilization such as number of hospital readmissions during the 180-day post-discharge period. METHODS Based on the level of exposure to opioids during the initial admission for the surgery, study cohort was grouped into two, High MME (ie, morphine milligram equivalent dose greater than median) and Low MME (ie, MME equal to or less than median). Patient characteristics and outcomes were summarized using descriptive statistics, and compared between the High MME and Low MME groups using bivariate comparison. The odds ratio of being a persistent opioid user for the High vs Low MME was adjusted for the baseline characteristics using a logistic regression model. Secondary outcomes were compared between the High MME and Low MME groups using bivariate analysis including student t-test, Wilcoxon Rank-sum test and Chi-square test. RESULTS Median (IQR) amount of opioid used during index procedure for High MME (N=1225) group and Low MME (N=1226) groups were 480 (371 – 668) mg and 136 (64 – 212) mg, respectively. The proportions of persistent opioid users defined by the 30-day cutoff were 42.4% of High MME and 36.8% of Low MME. When the 90-day cutoff was used, the respective proportions of persistent opioid users were 24.8% and 21.4%. The adjusted odds ratios (95% confidence interval) of being a persistent opioid user for High MME vs Low MME were 1.29 (1.09 - 1.53) for the 30-day cutoff and 1.27 (1.04 - 1.54) for the 90-day cutoff. The rate of ORADE over the 180-day post-discharge period was significantly higher among the High MME group compared to the rate from the Low MME group (31.8% vs 26.8%, p CONCLUSIONS An increase in opioid use during inpatient admission for spine surgery is associated with a higher rate of persistent opioid use, more frequent ORADE and a greater amount of resource utilization. Optimal pain management strategy that helps to reduce the opioid use during the surgery and inpatient postsurgical period could potentially decrease persistent opioid use and lower medical resource use and cost. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Opioid Dependence Subsequent to Exposure to Prescription Opioids

To determine whether the length, dose, and/or frequency of opioid prescriptions correlates with the subsequent diagnosis of opioid use disorder (OUD) among Medicaid enrollees and if there are higher odds of developing opioid dependence after receiving opioid prescriptions for dental procedures versus medical procedures.Our design was a nested case‐control in a cohort of continuously enrolled, opioid‐naïve (no opioid prescription for 1 year before the first prescription of opioid) Medicaid enrollees with at least one opioid prescription between January 1, 2013, and December 31, 2017, in IBM Watson Health’s MarketScan Medicaid database. The cases were defined as enrollees with diagnosed opioid use disorder, and controls were drawn from the same population who were not diagnosed with OUD. They were matched (up to 1:2) by age, sex, race, baseline pain diagnosis, number of Elixhauser comorbidities, and similar exposure time for prescription opioids. Outcome variable was the diagnosis of OUD, and the predictor variables were cumulative length of opioid prescriptions, morphine milligram equivalent (MME) dose, and frequency of opioids. The correlation was explored through multivariate logistic regression, and the model was re‐adjusted for baseline matching characteristics.The study population is opioid‐naïve Medicaid enrollees with at least one opioid prescription between January 1, 2013, and December 31, 2017, in IBM Watson Health’s MarketScan Medicaid database.Among a matched cohort of 1051 cases and 2053 controls, odds of OUD increased significantly for prescription count of 2‐3 (OR = 1.3, CI = 1.1‐1.6), 4‐5 days (OR = 2.0, CI = 1.4‐2.8), and above 6 (OR = 5.1, CI = 3.3‐7.8), compared to one prescription. Odds of OUD increased significantly for cumulative prescription length of 31‐60 days (OR = 1.8, CI = 1.3‐2.3), 61‐90 days (OR = 2.9, CI = 1.5‐5.6), and above 91 days (OR = 10.1, CI = 5.0‐20.4), compared to 5 days or less. Odds of OUD for average prescription length of 16‐30 days (OR = 1.9, CI = 1.3‐2.5) were significantly more compared to 5 days or less. Odds of OUD increased significantly for cumulative MME dose of 120‐180 (OR = 1.7, CI = 1.2‐2.3), and for 180 and above (OR = 4.1, CI = 2.8‐5.8), compared less than or equal to 20. Odds of OUD for average MME dose of 91 and above (OR = 1.9, CI = 1.2‐3.0) were significantly more compared less than or equal to 20. Moreover, enrollees who received opioid prescription for dental procedure were less likely (OR = 0.5, CI = 0.4‐0.7) to develop OUD then who received prescriptions for medical procedures.The study concluded that when number of prescriptions, days supplied, and morphine milligram equivalent dose go up, the odds of developing OUD increases significantly. Therefore a quantitative association between prescription opioid exposure and subsequent dependence in established. Moreover, the odds of developing OUD are less for prescriptions received after dental procedures compared to medical procedures.The study informs the opioid prescribing and opioid‐prescribing guidelines for clinical practice.DentaQuest Partnership for Oral Health Advancement.

Reformulation of oxycodone 80 mg to prevent misuse: A cohort study assessing the impact of a supply-side intervention

BackgroundIn August 2010, extended-release OxyContin® products, including oxycodone 80 mg, were reformulated and released as abuse-deterrent medications. This paper describes changes in individual prescription filling patterns that followed the reformulation of oxycodone 80 mg. MethodsUsing New York State prescription monitoring program data, we conducted a retrospective analysis of a cohort of New York City residents who had filled at least three consecutive prescriptions for oxycodone 80 mg immediately prior to the reformulation. We classified cohort members into one of three groups (continuers, switchers, and discontinuers) based on prescription filling patterns post-reformulation. Descriptive analyses were conducted to identify prevalence of filling patterns. Differences in median morphine milligram equivalents (MME) pre- and post-reformulation were compared using the Wilcoxon signed-rank sum test. Analyses were completed in 2018. ResultsA cohort of 4,098 New York City residents filled continuous prescriptions for oxycodone 80 mg immediately prior to reformulation. Post-reformulation, 14% of the cohort discontinued filling opioid analgesic prescriptions; 46% continued to fill prescriptions for oxycodone 80 mg; and 40% switched to a different opioid analgesic, most commonly oxycodone 30 mg. Post-reformulation, the median MME dose decreased significantly among all three groups: 45 mg among continuers, 150 mg among switchers, and 360 mg among discontinuers. ConclusionPost-reformulation, more than half the cohort changed their filling patterns. Following reformulation, median MME dose decreased significantly among the cohort. We hypothesize that the dramatic decrease in MME dose prompted many to transition to heroin in order to avoid severe withdrawal.

Prescribing patterns in a US dental school from 2010 to 2017.

Dental education has an essential role in helping combat the opioid and antibiotic resistance crises. This study evaluates the prescribing practices of clinical instructors, advanced graduate residents, and predoctoral students in an academic dental setting. A retrospective chart review was conducted of electronic dental records from the years 2010 to 2017. The proportions of prescriptions for each drug group was calculated by prescribers' training level and specialty. Descriptive statistics were calculated for the daily opioid Morphine Milligram Equivalent (MME) dose prescribed across years and provider characteristics. Over the 8 years, 65,160 prescriptions were written for 10,374 patients by 625 prescribers. The most commonly prescribed drugs were for fluoride-based medications (30%) and antibiotics (24%). Periodontists had the greatest absolute number of opioid analgesics prescriptions (n=2712); oral maxillofacial surgeons (OMFS) prescribed more opioids than other classes of drug (49%) as a proportion of within-specialty prescriptions. Antibiotics were the most common drugs prescribed by endodontists (46%) and second most common drugs prescribed by periodontists (25%), OMFS (28%), and prosthodontists (21%). From 2010 to 2017, the proportion of prescriptions for antibiotics remained unchanged, while that of fluoride-based drugs increased from 2010 to 2014 and plateaued thereafter. The proportion of prescriptions for opioid analgesics decreased from 18% to 7%. The median daily MME dose across year and provider characteristics stayed constant (<50MME). These results demonstrate encouraging prescription trends for opioid and fluoride-based drugs. Due to the high prevalence of antibiotic prescriptions in academic dental settings, stewardship approaches should be emphasized.

Age and postoperative opioid prescriptions: a population-based cohort study of opioid-naïve adults.

Opioids are commonly prescribed for acute pain after surgery. However, it is unclear whether these prescriptions are usually modified to account for patient age and, in particular, opioid-related risks among older adults. We therefore sought to describe postoperative opioid prescriptions filled by opioid-naïve adults undergoing four common surgical procedures. This retrospective cohort study used individually linked surgery and prescription opioid dispensing data from Ontario, Canada to create a population-based sample of 135 659 opioid-naïve adults who underwent one of four surgical procedures (laparoscopic cholecystectomy, laparoscopic appendectomy, knee meniscectomy, or breast excision) between 2013 and 2017. Patient age, in years, was categorized as 18 to 64, 65 to 69, 70 to 74, and 75 and over. Postoperative opioid prescriptions were identified as those filled on or within 6 days of surgical discharge date. For those who filled a prescription, we assessed the total morphine milligram equivalent (MME) dose, types of opioids, and any subsequent opioid prescriptions filled within 30 days of surgical discharge date. Results were presented stratified by surgical procedure. For three of the four surgical procedures we assessed, the proportion of patients who filled a postoperative opioid prescription decreased with age (P < 0.001 for trend), and there was a small shift in the type of opioid (more codeine or tramadol and less oxycodone; P < 0.001 for trend). However, the total MME dose of the initial prescription(s) filled showed minimal age-related trends. The proportion of opioid-naïve patients filling postoperative opioid prescriptions decreases with age. However, postoperative opioid prescription dosage is not typically different in older adults.

Contribution of psychiatric diagnoses to extent of opioid prescription in the first year post-head and neck cancer diagnosis: A longitudinal study.

The purpose of this study was to determine, within the first-year post-head and neck cancer (HNC) diagnosis, the contribution of past and upon HNC psychiatric diagnoses (ie, substance use disorder, major depressive disorder, and anxiety disorder) to the extent (ie, cumulated dose) of opioid prescription. Prospective longitudinal study of 223 consecutive adults (on 313 approached; 72% participation) newly diagnosed (<2weeks) with a first occurrence of primary HNC, including Structured Clinical Interviews for DSM-IV disorders, validated psychometric measures, and medical chart reviews. Opioid doses were translated into standardized morphine milligram equivalents (MME) using CDC guidelines. A model of variables was tested using multiple linear regression. Fifty-five percent (123/223) of patients received opioids at some point during the first 12months post-HNC diagnosis, 37.7% (84/223) upon HNC diagnosis (pre-treatment), 40.8% (91/223) during treatments, and 31.4% (70/223) post-treatment. The multiple linear regression indicated that an AD (P=0.04) upon HNC diagnosis in early stage contributes to cumulated MME dose in the first year post-HNC diagnosis. This study underlines how anxiety has important repercussions on the management of pain and illustrates the importance of screening for AD upon HNC diagnosis to allow for early prophylactic treatment and support.

Opioid dispensing patterns after oocyte retrieval

To study opioid dispensing patterns following oocyte retrieval. Retrospective cohort. Not applicable. Women undergoing oocyte retrieval with a maximum of 1 opioid prescription in the 12weeks prior to the procedure, without an opioid use or other substance use disorder. None. We measured the frequency of opioids dispensed within 3days of oocyte retrieval, most common opioids dispensed; and quantity dispensed, in median (interquartile range [IQR] and 10th-90th percentile ranges) oral morphine milligram equivalents (MME). Multivariate regression analyses were used to calculate odds ratios and 95% confidence intervals (CI) to examine the association between patient characteristics and the occurrence of an opioid dispensing. In total, 61,463 women with an oocyte retrieval met the criteria for analysis. After oocyte retrieval, 11.9% were dispensed an opioid, most commonly hydrocodone (48.5%), codeine (23.0%), and oxycodone (17.7%). The median (IQR; 10th-90th percentile) oral MME dose dispensed after retrieval was 90 (50-125; 50-207). Women with mood disorders (adjusted odds ratio [aOR] 1.17, 95% CI 1.00-1.36), tobacco use (aOR 1.67, 95% CI 1.18-2.37), or anti-depressant use (aOR 1.62, 95% CI 1.47-1.80) were more likely to fill an opioid prescription, compared to those without these diagnoses. Although only a small proportion of women fill a prescription for opioids after oocyte retrieval, there is substantial variation in the amount dispensed. Patients with a concurrent mood disorder or those taking anti-depressants were more likely to fill an opioid prescription.

Multiple opioid prescriptions among privately insured dental patients in the United States: Evidence from claims data

BackgroundMultiple or high dosage opioid prescriptions increase the risk of experiencing drug misuse and overdose. The authors examine index (first) and follow-up opioid prescriptions for 1 year among privately insured dental patients in the United States from 2010 through 2015. MethodsThe authors used the 2010 through 2015 Truven Health MarketScan Research databases and the Prescription Drug Monitoring Program Training Technical Assistance Center conversion data set. The authors analyzed index prescriptions, repeat prescriptions over 1 year, same-day multiple prescriptions, and concurrent prescriptions among dental patients. Descriptive analyses were conducted for days’ supply, quantity of opioids, daily morphine milligram equivalent (MME) dose, and total MME dose. ResultsApproximately 17.27% of all index prescriptions were dental related. The percentage of dental-related index prescriptions for age groups 11 through 18 years and 19 through 25 years was 23.51% and 23.41%, respectively. Approximately 80.87% of repeat prescriptions within 30 days of dental-related index prescriptions were dental related. In 39.07% of dental-related same-day multiple prescription incidents, the daily dose was greater than or equal to 50 MME. Approximately 58.28% of dental-related concurrent prescriptions were dispensed when an existing dental-related opioid prescription was available. ConclusionsDental-related index prescriptions were highest for the age groups 11 through 18 years and 19 through 25 years. The frequency of dental-related repeat prescriptions was the highest within 30 days of a dental-related index prescription. Practical ImplicationsLow dosages of opioids and the use of prescription drug monitoring programs before prescribing opioids may reduce the potential for drug misuse or overdose.

Relationship between high-risk patients receiving prescription opioids and high-volume opioid prescribers.

(1) To characterize the amount of prescription opioids prescribed for high-risk patients by low-volume prescribers; (2) to quantify how high- and low-volume prescribers differ systematically in their prescribing patterns. Cross-sectional study using 2015 longitudinal, all-payer QuintilesIMS pharmacy claims. We conducted an aggregated analysis for the first aim and an individual-level analysis for the second aim. California, Florida, Georgia, Maryland, and Washington, USA. Among 4 046 275 patients, we identified 375 848 concomitant users (filling more than 30-days of concomitant opioids and benzodiazepines), 150 814 chronic users (using 100+ morphine milligram equivalents (MMEs) per day for more than 90days), and 3190 patients prescribed opioids by >3 prescribers and filling opioids at >3 pharmacies during any 90-day period. Among 192 126 prescribers, we identified 8023 high-volume prescribers, who comprised the highest fifth percentile of opioid volume during four calendar quarters. (1) MME dose per transaction, (2) days supplied per transaction, (3) total opioid volume per patient and (4) number of prescriptions per patient. We also examined differences in opioid dispensing between high- and low-volume prescribers among patients receiving opioids from both. Low-volume prescribers accounted for 15-29% of opioid volume and 18-56% of opioid prescriptions for high-risk patients, compared with 28-37% and 53-58% for low-risk patients. After accounting for state of residence, comorbid burden, prescriber specialty and care sequence, patients were more likely to receive higher doses (60.9 versus 53.2 MMEs per day, P<0.01), longer supplies (22.1 versus 15.6 days, P<0.01), more prescriptions (4.0 versus 2.6 prescriptions, P<0.01) and greater opioid volume (5.6 versus 1.9 g, P<0.01) from high- than low-volume prescribers. In the United States, high-risk patients obtain a substantial proportion of prescription opioids from low-volume prescribers. The differences in prescribing patterns between high- and low-volume prescribers suggest the importance of interventions targeting prescriber behaviors.