Patterns Of Opioid Use Research Articles

Patterns of Opioid Use in Gynecologic Oncology Surgical and Cancer Surveillance Patients

OBJECTIVES: Describe current patterns of opioid prescription, supportive/pain service utilization, and patient concerns in surgical and surveillance patients from a large gynecologic oncology (GO) practice.

Prevalence and Patterns of Opioid Use Before and After Liver Transplantation.

Opioid use in liver transplantation is poorly understood and has potential associated morbidity. Using a national data set of employer-based insurance claims, we identified 1257 adults who underwent liver transplantation between December 2009 and February 2015. We categorized patients based on their duration of opioid fills over the year before and after transplant admission as opioid-naive/no fills, chronic opioid use (≥120 d supply), and intermittent use (all other use). We calculated risk-adjusted prevalence of peritransplant opioid fills, assessed changes in opioid use after transplant, and identified correlates of persistent or increased opioid use posttransplant. Overall, 45% of patients filled ≥1 opioid prescription in the year before transplant (35% intermittent use, 10% chronic). Posttransplant, 61% of patients filled an opioid prescription 0-2 months after discharge, and 21% filled an opioid between 10-12 months after discharge. Among previously opioid-naive patients, 4% developed chronic use posttransplant. Among patients with pretransplant opioid use, 84% remained intermittent or increased to chronic use, and 73% of chronic users remained chronic users after transplant. Pretransplant opioid use (risk factor) and hepatobiliary malignancy (protective) were the only factors independently associated with risk of persistent or increased posttransplant opioid use. Prescription opioid use is common before and after liver transplant, with intermittent and chronic use largely persisting, and a small development of new chronic use posttransplant. To minimize the morbidity of long-term opioid use, it is critical to improve pain management and optimize opioid use before and after liver transplant.

Outcomes of advanced gastrointestinal (GI) cancer patients in relationship to opioid use: An individual patient data pooled analysis from eight clinical trials.

687 Background: The current study aims at assessing the patterns of opioid use, and evaluating the impact of opioid use on survival outcomes among patients with advanced GI cancers who were included in eight clinical trials. Methods: De-identified datasets of eight clinical trials evaluating first-line systemic treatment for advanced GI cancers (NCT01124786; NCT00844649; NCT00290966; NCT00678535; NCT00699374; NCT00272051; NCT00305188; NCT00384176) were accessed from the Project Data Sphere platform. These trials evaluated patients with pancreatic, gastric, hepatocellular and colorectal carcinoma. Multivariable logistic regression analysis was used to evaluate factors predicting the use of opioids. Kaplan-Meier survival estimates were used to compare survival outcomes in each disease entity among patients who did or did not receive opioid treatment. Multivariable Cox regression analysis was used to assess the impact of opioid use on survival outcomes in each disease entity. Results: A total of 3441 participants were included in the current analysis. The following factors predicted a higher probability of opioid use within logistic regression analysis: younger age (P = 0.004), non-white race (P = 0.010), higher ECOG score (P < 0.001) and pancreatic primary site (P < 0.001). Use of opioids was consistently associated with worse overall survival in Kaplan-Meier survival estimates of each disease entity (for pancreatic cancer: P = 0.008; for gastric cancer: P < 0.001; for hepatocellular carcinoma: P < 0.001 and for colorectal cancer: P < 0.001). Within multivariable Cox regression analysis, opioid use was associated with worse overall survival among patients with pancreatic cancer (HR = 1.245; 95% CI: 1.063-1.459; P = 0.007), gastric cancer (HR = 1.725; 95% CI: 1.403-2.122; P < 0.001), hepatocellular carcinoma (HR = 1.841; 95 CI: 1.480-2.290; P < 0.001) and colorectal cancer (HR = 1.651; 95% CI: 1.380-1.975; P < 0.001). Conclusions: Opioid use is consistently associated with worse overall survival among patients with different GI cancers. Further studies are needed to evaluate the underlying mechanisms of this observation.

Exploration of change in persistence patterns of opioid use among patients with non‐cancer and cancer pain over a 3‐year follow‐up period

AbstractBackgroundLittle is known about the different patterns of persistent opioid use and whether the patterns of clinical opioid use remain the same throughout long‐term opioid therapy.AimThis study explored the different patterns of persistent opioid use and changes in these patterns over time in patients with non‐cancer and cancer pain.MethodsThis retrospective cross‐sectional study included patients with non‐cancer and cancer pain receiving opioid prescriptions during 2013–15 at outpatient tertiary hospital settings in Malaysia. A three‐dimensional (3D) persistence measure consisting of treatment intensity, frequency and distribution was used to define persistent opioid users as ‘wide’ (use opioids most of the days in a year), ‘intermediate’ (use opioids daily) or ‘strict’ (use opioids continuously to achieve a therapeutic concentration) users. The number of patients in each persistence group and changes in persistence patterns over time were recorded.ResultsMost persistent opioid users in the non‐cancer and cancer groups were defined as wide users (9.3% and 4.8%, respectively), followed by intermediate (3.1% and 0.5%, respectively) and strict (1.8% and 0.9%, respectively) users. Over the 3‐year study period, a change to a less stringent persistence definition was observed in the non‐cancer group, whereas no discernible pattern of change was observed in the cancer group.ConclusionChanges in the patterns of clinical opioid use over time were detected among persistent opioid users in both the non‐cancer and cancer groups using a 3D persistence measure. This measure, which is sensitive to changes in the clinical use of opioids over time, could affect future research and practices for better pain management involving opioids.

Factors Associated With Frequent Opioid Use in Children With Acute Recurrent and Chronic Pancreatitis.

The aim of the study was to understand the association of frequent opioid use with disease phenotype and pain pattern and burden in children and adolescents with acute recurrent (ARP) or chronic pancreatitis (CP). Cross-sectional study of children <19 years with ARP or CP, at enrollment into the INSPPIRE cohort. We categorized patients as opioid "frequent use" (daily/weekly) or "nonfrequent use" (monthly or less, or no opioids), based on patient and parent self-report. Of 427 children with ARP or CP, 17% reported frequent opioid use. More children with CP (65%) reported frequent opioid use than with ARP (41%, P = 0.0002). In multivariate analysis, frequent opioid use was associated with older age at diagnosis (odds ratio [OR] 1.67 per 5 years, 95% confidence interval [CI] 1.13-2.47, P = 0.01), exocrine insufficiency (OR 2.44, 95% CI 1.13-5.24, P = 0.02), constant/severe pain (OR 4.14, 95% CI 2.06-8.34, P < 0.0001), and higher average pain impact score across all 6 functional domains (OR 1.62 per 1-point increase, 95% CI 1.28-2.06, P < 0.0001). Children with frequent opioid use also reported more missed school days, hospitalizations, and emergency room visits in the past year than children with no frequent use (P < 0.0002 for each). Participants in the US West and Midwest accounted for 83% of frequent opioid users but only 56% of the total cohort. In children with CP or ARP, frequent opioid use is associated with constant pain, more healthcare use, and higher levels of pain interference with functioning. Longitudinal and prospective research is needed to identify risk factors for frequent opioid use and to evaluate nonopioid interventions for reducing pain and disability in these children.

Patterns of opioid use and treatment in a cohort of patients from the Anuradhapura district

The Sri Lanka Journal of Psychiatry (SLJP) is a peer-reviewed, open access journal published bi annually by the Sri Lanka College of Psychiatrists.The Journal publishes original papers, brief reports including case reports and commentaries relevant to psychiatry and allied sciences. The Sri Lanka Journal of Psychiatry is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.Cover: Doorways: When one is ill, having somewhere to stay, where one is looked after, is usually a relief to the patient who is not well and his/her family. The picture shows the doorway to what remains of an ancient hospital in Mihintale, said to date back two millennia. Thilini Rajapakse, Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Sri Lanka.

Transcranial Direct Current Stimulation for Opioid use disorder: Protocol for a pilot randomized controlled trial

Opioid use disorder (OUD) is a chronic relapsing condition which is characterized by problematic pattern of opioid use despite of physical, mental and social distress. It is important individual and public health problem worldwide, especially in USA due to increased non-medical use of prescription opioids. Medication assisted treatment (MAT) is a gold standard for treatment of OUD which includes pharmacological treatment combined with psychosocial therapies. Though these treatments are effective, there are barriers for successful outcomes. Transcranial direct current stimulation (tDCS) is a safe, simple and effective technique to modulate neuronal excitability. It has been used to reduce craving in substance use disorder (SUD). tDCS may be used in opioid use disorder to reduce craving and drug use. We are proposing pilot, randomized, double blind, placebo-controlled trial protocol to assess effects of anodal tDCS over left dorsolateral prefrontal cortex (DLPFC), in OUD. We will randomize 80 subjects in parallel group design to either active or sham group. Five stimulation sessions of 2 mA for 20 minutes, will be provided. Primary outcome is cue induced craving score on VAS of 0 -10. Measures of feasibility, safety and effectiveness will be assessed at baseline and at different time points over 6 weeks. Aim of this trial is to assess feasibility of tDCS to reduce cue induced craving in OUD and to provide data for future fully powered trials, if trend of effectiveness observed.

Patterns of opioid use in patients with trigeminal neuralgia undergoing neurosurgery.

First-line treatment for trigeminal neuralgia (TN) is pharmacological management using antiepileptic drugs (AEDs), e.g., carbamazepine (CBZ) and oxcarbazepine (OCBZ). Surgical intervention has been shown to be an effective and durable treatment for TN that is refractory to medical therapy. Despite the lack of evidence for efficacy in patients with TN, the authors hypothesized that patients with neuropathic facial pain are prescribed opioids at high rates, and that neurosurgical intervention may lead to a reduction in opioid use. This is a retrospective study of patients with facial pain seen by a single neurosurgeon. All patients completed a survey on pain medications, medical comorbidities, prior interventions for facial pain, and a validated pain outcome tool (the Penn Facial Pain Scale). Patients subsequently undergoing neurosurgical intervention completed a survey at the 1-month follow-up in the office, in addition to telephone interviews using a standardized script between 1 and 6 years after intervention. Univariate and multivariate logistic regression were used to predict opioid use. The study cohort consisted of 309 patients (70% Burchiel type 1 TN [TN1], 18% Burchiel type 2 [TN2], 6% atypical facial pain [AFP], and 6% TN secondary to multiple sclerosis [TN-MS]). At initial presentation, 20% of patients were taking opioids. Of these patients, 55% were receiving concurrent opioid therapy with CBZ/OCBZ, and 84% were receiving concurrent therapy with at least one type of AED. Facial pain diagnosis (for diagnoses other than TN1, odds ratio [OR] 2.5, p = 0.01) and facial pain intensity at its worst (for each unit increase, OR 1.4, p = 0.005) were predictors of opioid use at baseline. Neurosurgical intervention led to a reduction in opioid use to 8% at long-term follow-up (p < 0.01, Fisher's exact test; n = 154). Diagnosis (for diagnoses other than TN1, OR 4.7, p = 0.002) and postintervention reduction in pain at its worst (for each unit reduction, OR 0.8, p < 10-3) were predictors of opioid use at long-term follow-up. On subgroup analysis, patients with TN1 demonstrated a decrease in opioid use to 5% at long-term follow-up (p < 0.05, Fisher's exact test), whereas patients with non-TN1 facial pain did not. In the nonsurgical group, there was no statistically significant decrease in opioid use at long-term follow-up (n = 81). In spite of its high potential for abuse, opioid use, mostly as an adjunct to AEDs, is prevalent in patients with facial pain. Opportunities to curb opioid use in TN1 include earlier neurosurgical intervention.

Understanding the Implications of a Shifting Opioid Landscape in Ontario.

North America is currently in the midst of an opioid overdose crisis, leading to changes in drug policy and clinical practice guideline recommendations. Data from Ontario's prescription monitoring program and the Office of the Chief Coroner for Ontario can be used to characterize changing prescription opioid trends and their role in fatal opioid overdoses. A better understanding of historical patterns of opioid use and overdose can help inform a more nuanced drug policy in the future.

Opioid Use for Treatment of Acute Pain Among Children and Adolescents Enrolled in the Mississippi Medicaid Program

Background: Abuse of opioids among children and adolescents has become a major public concern in the United States. Understanding the epidemiology of opioid use in this vulnerable population is critical to address opioid abuse. Objective: The aim of this study is to characterize opioid use for the treatment of acute pain among children and adolescents enrolled in Mississippi Medicaid and to determine the effects of related clinical factors (ie, mental health disorders and obstructive sleep apnea [OSA] on patterns of opioid use. Methods: A retrospective cohort study was conducted using the Mississippi Medicaid administrative claims data from October 2015 through December 2017. We examined the proportion of children and adolescents less than 21 years of age using opioids within 7 days following any qualifying acute pain episode, as well as the difference in opioid use patterns between individuals with various demographic and clinical characteristics. Results: Over 5% of the eligible population received opioids within 7 days of a qualifying pain episode. The majority received schedule II or schedule III to IV short-acting opioids. There was no significant difference in opioid use for acute pain between individuals with and without a mental health disorder. Opioid use for acute pain was significantly more likely among those with a history of OSA than those without OSA. Conclusion: This study characterizes the nature and patterns of opioid use among children and adolescents with acute pain. Further research is needed to understand the role of clinical and other demographic factors in the prescribing of opioids for acute pain in this population.

Changes in use of opioid therapy after colon cancer diagnosis: a population-based study.

To describe patterns of opioid use in cancer survivors. In a cohort study of colon cancer patients diagnosed during 1995-2014 and enrolled at two Kaiser Permanente regions, we constructed quarterly measures of opioid use from 1year before cancer diagnosis through 5years after diagnosis to examine changes in use. Measures included any use, incident use, regular use (use ≥ 45days in a 91-day quarter), and average daily dose (converted to morphine milligram equivalent, MME). We also assessed temporal trends of opioid use. Of 2,039 colon cancer patients, 11-15% received opioids in the four pre-diagnosis quarters, 68% in the first quarter after diagnosis, and 15-17% in each subsequent 19 quarters. Regular opioid use increased from 3 to 5% pre-diagnosis to 5-7% post diagnosis. Average dose increased from 15 to 17 MME/day pre-diagnosis to 14-22 MME/day post diagnosis (excluding the quarter in which cancer was diagnosed). Among post-diagnosis opioid users, 73-95% were on a low dose (< 20 MME/day). Over years, regular use of opioids increased in survivorship with no change in dosage. Opioid use slightly increased following a colon cancer diagnosis, but high-dose use was rare. Research is needed to differentiate under- versus over-treatment of cancer pain.

Utilizing social media to explore overdose and HIV/HCV risk behaviors among current opioid misusers

IntroductionOpioid misuse has evolved into an American health crisis over the past decade, becoming a public health epidemic. Measures need to be taken to prevent overdoses by opioid misuse as well as prevent the transition into injection drug use, a high risk factor for contracting HIV/HCV. This study utilized social media to survey individuals currently misusing opioids to identify groups of individuals with different risk and use patterns. MethodsWe recruited participants for our online survey from Reddit. Five risk behaviors were used to characterize overdose and HIV/HCV risk groups. Gender, age, and socioeconomic status were also included in the analyses, as well as items outlining social media use surrounding opioids. ResultsTwo groups of participants were characterized by high likelihoods of different combinations of risky behaviors: (1) Overdose Risk Group and (2) Sexual Risk Group. Those in the Overdose Risk Group were more likely to be younger in age and female, and this group was more likely to desire or be ready for treatment relative to the lowest risk group. Those in the Sexual Risk Group were more likely to be of a minority race/ethnicity, to desire or be ready for treatment, and to post more often on Reddit about opioid use. DiscussionThe results of this study illustrate patterns of opioid use and risk behaviors to inform tailored outreach and treatment efforts for groups of opioid misusers and suggests the potential for utilizing social media as a tool to engage these individuals into treatment and recovery activities.

Patient Outcomes Following Initiation of Medical Cannabis in Women with Chronic Pelvic Pain

Study Objective The aim is to evaluate the efficacy and side effects of medical cannabis for chronic pelvic pain (CPP). Design We conducted a retrospective cohort study between 2012 and 2018. Setting N/A Patients or Participants Three gynecologists specialized in pelvic pain who prescribe medical marijuana in their practice for analgesia participated. Only patients with CPP were included. Interventions 3 grams of medical cannabis daily was prescribed. Measurements and Main Results A descriptive analysis assessing patient baseline characteristics was performed. The usage of medical cannabis was recorded. Patient outcomes following initiation of medical cannabis were studied. Primary outcome was pain response; secondary outcomes were side effects and resulting patterns of opioid use. Chi-square test was used to compare association between different variables. P-value of A total of 135 women, with mean age of 35.4 years old, were prescribed medical cannabis. 92.6% were premenopausal. 8.9% underwent hysterectomy. 48.2%, 60.0% and 57% tried at least one type of NSAID, opioid, or neuromodulator respectively. The route of cannabis administration was documented in 38 charts. Some patients used more than one formulation. 25 patients used cannabis oil, 10 ingested edibles, 9 vaporized cannabis and 6 smoked marijuana. Change in pain was documented in 82 cases: 79 experienced improvements, and 3 reported no change. No patient had worsening of pain. Of the patients who had improvement, 39 reduced their opioids use. Side effects were reported by 9 patients—the most common being headache. No significant relationship between patient baseline characteristics and change in pain was found. Conclusion This is the first study reporting use of medical cannabis in CPP. Medical cannabis is a safe treatment with minimal side effects that can improve CPP and reduce opioids use. Future studies evaluating the pharmacokinetics and optimal regimen in the management of CPP are needed.

Suicidal motivations reported by opioid overdose survivors: A cross-sectional study of adults with opioid use disorder

BackgroundPrior studies in heroin use disorder reported low rates (10%) of suicidal intention with non-fatal opioid overdose but did not assess dimensional ratings of suicidal ideation. This study aims to quantify the frequency and intensity of ratings of desire to die and perceived overdose risk proximal to the most recent opioid overdose event among individuals admitted for opioid use disorder detoxification/stabilization. MethodsCross-sectional study (June 2017-July 2018) assessing patterns of opioid use and variables related to overdose history was conducted in a not-for-profit psychiatric hospital. Adults (>18 years) with opioid use disorder were eligible and 120 of 122 participants completed all measures. Forty-one percent were women and 85% self-identified as white. Participants’ perceptions of the likelihood of overdose and their suicidal motivations (defined as desire to die) prior to most recent opioid overdose was self-rated on a scale of 0 (no desire to die/no risk of death) to 10 (I definitely wanted to die/I definitely thought I would die). ResultsMost (92%) surviving opioid overdose used heroin/fentanyl; over half reported some desire to die prior to their most recent overdose, with 36% reporting strong (>7/10) desire to die and 21% reporting 10/10 “I definitely wanted to die.” Perceptions of overdose risk were also variable, with 30% reporting no (0/10) likelihood of overdose and 13% reporting a high (10/10) likelihood. ConclusionsSuicidal motivation prior to opioid overdose is common and falls along a continuum of severity. Longitudinal studies are needed to determine if suicide prevention interventions may reduce opioid overdose in those at risk.

Patterns of opioid use (codeine, morphine or meperidine) in the Canadian population over time: analysis of the Longitudinal National Population Health Survey 1994–2011

ObjectiveThis study aimed to investigate cohort effects in selected opioids use and determine whether cohort differences were associated with changes in risk factors for use over time.DesignThis study presents secondary...

Trends in opioid use in patients undergoing primary surgery for cervical cancer.

e17014 Background: In response to the opioid epidemic, restrictions on prescribing opioids for pain management may result in unintended consequences for patients with cancer-related pain. Factors that place women at higher risk for opioid misuse include age, insurance status, tobacco use and a diagnosis of cervical cancer. Our objective was to describe describe patterns of opioid use and prescribing practices over time. Methods: We performed a retrospective study of patients diagnosed with cervix cancer enrolled in our institution’s Health Registry/Cancer Survivorship Cohort from 5/2010-3/2017. The dataset included demographics, clinicopathologic data, reported opioid use (prior, during and after treatment) and prescription history from the EMR after IRB approval. This preliminary analysis included frequencies, cross-tabulations, and measures of distributional characteristics. Results: Of the 122 patients identified, 94 had surgery. Mean age at diagnosis was 44.7 yrs and BMI was 29.13. Eighteen (19.1%) patients had an opioid use history. Given changes in EMR documentation in 2014, 37 were excluded as assessment of opioid use and prescriptions was limited to only MD documentation. While there was no pre-defined protocol change, post-operative opioid prescribing practices changed in late 2014. From 5/2014-11/2014, 17 patients underwent surgery with 88% receiving prescriptions for 40 tablets of an opioid. From 12/2014-12/2016, 40 patients underwent surgery with 27.5% receiving prescriptions for 40 tablets of an opioid and 65% receiving 20-30 tablets. Prior to 12/2014, 1/16 patients (6.3%) required additional opioids postoperatively with no documented complication compared to 9/40 patients (22.5%) after 12/2014. In this group, most frequent prescriptions were coming from the patient’s gynecologic oncologist and/or a primary care provider. Conclusions: We saw a small increase in additional opioids after the routine number prescribed declined. However, this comprised a minority of patients. Monitoring of the opioid needs and use among women with cervix cancer will aid in the development of clinically-tailored guidelines to replace the current reactionary restrictions on treatment for all patients.

PDG42 OPIOID USE FOR TREATMENT OF ACUTE PAIN AMONG CHILDREN AND ADOLESCENTS ENROLLED IN THE MISSISSIPPI MEDICAID PROGRAM

Abuse of opioids among children and adolescents has become a major public concern. Understanding the epidemiology of opioid use in this vulnerable population is critical to address opioid abuse. This study aimed to characterize patterns of opioid use for treatment of acute pain (such as postoperative pain of tonsillectomy and/or adenoidectomy, burns, and common acute non-cancer pain) among children and adolescents enrolled in Mississippi Medicaid. A retrospective cohort study was conducted using the Mississippi Medicaid data from July 2015 through December 2017. The proportion of children and adolescents less than 21 years of age using opioids within seven days following any qualifying acute pain episode was examined. Dose, duration, and type of opioid therapy were recorded in each case. A three-month washout period prior to the prescription index date was used to identify presence of mental health disorders, obstructive sleep apnea, and other comorbidities. Bivariate analyses were used to test differences in opioid use characteristics among various demographic variables and preexisting clinical characteristics. A total of 164,787 beneficiaries with a qualifying acute pain episode were included in the study. Of these, 8,448 (5.1%) received an opioid prescription within seven days following an acute pain episode. Beneficiaries between the ages of 18 and 21, caucasians, and males were more likely to receive opioids. The majority received Schedule II or III-IV short-acting opioids. There was no significant association between the use of opioids for acute pain and the presence of MH disorders. The results provide evidence that can help develop strategies for encouraging appropriate use of opioids following acute pain among children and adolescents. Further studies are needed to investigate the influence of clinical risk factors such as mental health disorders and obstructive sleep apnea on the prescription of opioids for treatment of acute pain in this population.

Evaluation of Machine-Learning Algorithms for Predicting Opioid Overdose Risk Among Medicare Beneficiaries With Opioid Prescriptions

Current approaches to identifying individuals at high risk for opioid overdose target many patients who are not truly at high risk. To develop and validate a machine-learning algorithm to predict opioid overdose risk among Medicare beneficiaries with at least 1 opioid prescription. A prognostic study was conducted between September 1, 2017, and December 31, 2018. Participants (n = 560 057) included fee-for-service Medicare beneficiaries without cancer who filled 1 or more opioid prescriptions from January 1, 2011, to December 31, 2015. Beneficiaries were randomly and equally divided into training, testing, and validation samples. Potential predictors (n = 268), including sociodemographics, health status, patterns of opioid use, and practitioner-level and regional-level factors, were measured in 3-month windows, starting 3 months before initiating opioids until loss of follow-up or the end of observation. Opioid overdose episodes from inpatient and emergency department claims were identified. Multivariate logistic regression (MLR), least absolute shrinkage and selection operator-type regression (LASSO), random forest (RF), gradient boosting machine (GBM), and deep neural network (DNN) were applied to predict overdose risk in the subsequent 3 months after initiation of treatment with prescription opioids. Prediction performance was assessed using the C statistic and other metrics (eg, sensitivity, specificity, and number needed to evaluate [NNE] to identify one overdose). The Youden index was used to identify the optimized threshold of predicted score that balanced sensitivity and specificity. Beneficiaries in the training (n = 186 686), testing (n = 186 685), and validation (n = 186 686) samples had similar characteristics (mean [SD] age of 68.0 [14.5] years, and approximately 63% were female, 82% were white, 35% had disabilities, 41% were dual eligible, and 0.60% had at least 1 overdose episode). In the validation sample, the DNN (C statistic = 0.91; 95% CI, 0.88-0.93) and GBM (C statistic = 0.90; 95% CI, 0.87-0.94) algorithms outperformed the LASSO (C statistic = 0.84; 95% CI, 0.80-0.89), RF (C statistic = 0.80; 95% CI, 0.75-0.84), and MLR (C statistic = 0.75; 95% CI, 0.69-0.80) methods for predicting opioid overdose. At the optimized sensitivity and specificity, DNN had a sensitivity of 92.3%, specificity of 75.7%, NNE of 542, positive predictive value of 0.18%, and negative predictive value of 99.9%. The DNN classified patients into low-risk (76.2% [142 180] of the cohort), medium-risk (18.6% [34 579] of the cohort), and high-risk (5.2% [9747] of the cohort) subgroups, with only 1 in 10 000 in the low-risk subgroup having an overdose episode. More than 90% of overdose episodes occurred in the high-risk and medium-risk subgroups, although positive predictive values were low, given the rare overdose outcome. Machine-learning algorithms appear to perform well for risk prediction and stratification of opioid overdose, especially in identifying low-risk subgroups that have minimal risk of overdose.

Long-term prescription opioid utilization, substance use disorders, and opioid overdoses after adolescent trauma.

Injured adolescents have a 56% increased risk of developing a substance use disorder (SUD) within 3 years of their injury. The transition from medical prescription opioid use to nonmedical use in adolescent trauma patients has not been longitudinally studied long-term. The aim of this study is to describe 5-year patterns of opioid use in a cohort of injured adolescents as well as the proportion of patients experiencing overdose and SUD diagnoses. Our retrospective cohort study consisted of 736 patients aged 12 years to 18 years who were admitted for trauma from 2011 to 2013. We examined up to 5 years of regional health information exchange data containing information on prescription fills as well as diagnoses from inpatient, outpatient, and emergency department encounters. At 1 year, over 20% of adolescents filled more than two opioid prescriptions after being discharged for their injury; and at 4 years, over 13% had received more than eight opioid fills. Over the 5-year period, 11% received an opioid antagonist injection, 14% received an SUD diagnosis, and 8% had an overdose diagnosis. Relatively few patients had diagnoses for other mental health conditions including depression (5.5%), posttraumatic stress disorder (2.1%), and chronic pain (3.6%). Opioid usage remains high for multiple years in a subset of the adolescent trauma population. Mental health diagnosis rates were substantially lower in injured adolescents than what has been reported in adults. However, overdose and SUD diagnoses occur in over 1 in 10 adolescents within 5 years of their injury. Prognostic and epidemiological study, level IV.

Patterns of Opioid Use in the 12 Months Following Geriatric Fragility Fractures: A Population-Based Cohort Study

ObjectivesFractures of the hip, distal radius, and proximal humerus are common in the Medicare population. This study's objective was to characterize patterns and duration of opioid use, including regional variations in use, after both surgical and nonoperative management. DesignPopulation-based cohort study. Setting and participantsA cohort of opioid-naïve community-dwelling US Medicare beneficiaries who survived a hip, distal radius, or proximal humerus fracture between January 1, 2007 and December 31, 2010. Cohort members were required to be opioid-naïve for 4 months prior to fracture. MeasuresWe analyzed the proportion of patients with an active opioid prescription in each month following the index fracture, and report continued fills at 12 months postfracture. We also compared opioid prescription use in fractures treated surgically and nonsurgically and characterized state-level variation in opioid prescription use at 3 months postfracture. ResultsThere were 91,749 patients included in the cohort. Hip fracture patients had the highest rate of opioid use at 12 months (6.4%), followed by proximal humerus (5.7%), and distal radius (3.7%). Patients who underwent surgical fixation of proximal humerus and wrist fractures had higher rates of opioid use in each of the first 12 postoperative months compared with those managed nonoperatively. There was significant variation of opioid use at the state level, ranging from 7.6% to 18.2% of fracture patients filling opioid prescriptions 3 months after the index fracture. Conclusions/ImplicationsOpioid-naïve patients sustaining fragility fractures of the hip, proximal humerus, or distal radius are at risk to remain on opioid medications 12 months after their index injury, and surgical management of proximal humerus and distal radius fractures increases opioid use in the 12 months after the index fracture. There is significant state-level variation in opiate consumption after index fracture in nonvertebral geriatric fragility fractures. Opportunity exists for targeted quality improvement efforts to reduce the variation in opioid use following common geriatric fragility fractures.