Trends In Opioid Prescriptions Research Articles

Oral opioid prescribing to active duty US military personnel: a cross-sectional population

IntroductionWhile civilian opioid prescriptions have seen a dramatic decline in recent years, there are few studies investigating trends in opioid prescription in the active duty military population. We evaluated oral...

Two-year Opioid Prescription Trends in Local Sanitary Agency Naples 3 South, Campania Region, Italy. Descriptive Analyses and AI-based Translational Perspectives.

This study delves into the two-year opioid prescription trends in the Local Sanitary Agency Naples 3 South, Campania Region, Italy. The research aims to elucidate prescribing patterns, demographics, and dosage categories within a population representing 1.7% of the national total. Perspectives on artificial intelligence research are discussed. From the original dataset, spanning from January 2022 to October 2023, we processed multiple variables including demographic data, medications, dosages, drug consumption, and administration routes. The dispensing quantity was calculated as defined daily doses (DDD). The analysis reveals a conservative approach to opioid therapy. In subjects under the age of 20, prescriptions accounted for 2.1% in 2022 and declined to 1.4% in 2023. The drug combination paracetamol/codeine was the most frequently prescribed, followed by tapentadol. Approximately two-thirds of the consumption pertains to oral formulations. Transdermal formulations were 15% (fentanyl 9.8%, buprenorphine 5.1%) in 2022; and 16.6% (fentanyl 10%, buprenorphine 6.6%) in 2023. These data were confirmed by the DDD analysis. The trend analysis demonstrated a significant reduction ( p < 0.001) in the number of prescribed opioids from 2022 to 2023 in adults (40-69 years). The study of rapid-onset opioids (ROOs), drugs specifically used for breakthrough cancer pain, showed higher dosage (>267 mcg) consumption among women, whereas a lower dosage (<133 mcg) was calculated for men. Fentanyl pectin nasal spray accounted for approximately one-fifth of all ROOs. Despite limitations, the study provides valuable insights into prescribing practices involving an important study population. The findings underscore the need for tailored approaches to prescribing practices, recognizing the complexities of pain management in different contexts. This research can contribute to the ongoing discourse on opioid use, advocating for innovative strategies that optimize therapeutic outcomes while mitigating potential risks.

Interspecialty Opioid Prescribing Patterns in Ophthalmology Following Declaration of a Public Health Emergency.

Purpose: Previous literature has investigated opioid prescription trends in ophthalmology at large, however, little has been done looking at differences between subspecialties. We evaluate if significant trends exist among subspecialties in opioid prescribing patterns. This study aims to illuminate potential over-usage of opioids in ophthalmology that could compromise patient quality of life. Methods: Medicare data and "National Plan and Provider Enumeration System (NPPES) Downloadable File" were queried for cases of ophthalmologists with nonsuppressed opioid prescription data from 2014 to 2019. Ophthalmologists with no subspecialty code or missing regional, gender, degree, or graduation information were excluded. Chi-squared analysis, analysis of variance, t-tests, and multivariate logistic regression were utilized. Results: Five thousand one hundred forty-three physician records were included in analysis, 450 of which were by cornea subspecialists. Most cornea cases were male, graduated before 2005, and practiced in the South. All subspecialties had a significantly increased likelihood of making opioid claims and higher prescription rates compared with cornea (P < 0.050) besides glaucoma (P = 0.357). Only oculoplastics had significantly increased likelihood of greater total supply of opioids compared with cornea (odds ratio [OR] = 22.195, 95% confidence interval [CI] = 12.209-40.350, P < 0.001), while pediatrics (OR = 4.036, 95% CI = 1.377-11.831, P = 0.011) and neuro-ophthalmology (OR = 4.158, 95% CI = 1.237-13.975, P = 0.021) in addition to oculoplastics (OR = 64.380, 95% CI = 26.306-157.560, P < 0.001) were predicted to have significantly greater opioid beneficiaries. Males, the South/Midwest, and graduating before 2005, all were generally associated with increased likelihood of greater total opioid claims, supply, beneficiaries, and prescription rate (P < 0.050). Conclusion: Subspecialty, demographic, chronological, and regional trends exist for opioid prescribing patterns in ophthalmology.

A comparison of opioid prescription trends in England and the United States from 2008 to 2020.

The prescription opioid epidemic in the United States (US) is well documented, and recent measures have reduced prescribing rates in that country. Evidence suggests opioid prescriptions have been rising recently in other countries too. The current paper aimed to compare trends in opioid prescribing in England and the US. Trends in rates of prescriptions per 100 members of the population were calculated for England and the US using publicly available government data on prescriptions and population statistics. Rates of prescribing are converging. At the peak of the US epidemic in 2012, there were 81.3 prescriptions per 100 people, but this had fallen to 43.3 by 2020. Prescribing peaked in England in 2016 at 43.2 prescriptions per 100 people, but has fallen only slightly, so that in 2020 there were 40.9 prescriptions per 100 people. The data indicate that levels of opioid prescribing in England are now similar to those in the US. They remain high in both countries, despite recent falls. This suggests the need for further measures to prevent over-prescribing and to support people who would benefit from withdrawing from these drugs.

Tracking changes in opioid prescriptions dispensed following the enactment of a prescription drug monitoring program use mandate

BackgroundPrescription drug monitoring programs (PDMPs) are state-based surveillance tools used to track controlled substances dispensed to patients and identify patients at-risk of misuse. Starting April 2017, Wisconsin required all prescribers access PDMP to review patient information before issuing a controlled substance prescription order for more than a 3-day supply. A primary goal of PDMP use mandates is to reduce avoidable prescribing and mitigate opioid related mortality and morbidity. Current literature has not evaluated the existence of a time point post-policy implementation, at which the trend in opioid dispensing changes, reflecting normalization/maintenance of opioid prescribing. ObjectiveWe sought to evaluate the impact of the PDMP use mandate on trends in opioid prescriptions dispensed and test a hypothesis that a change or inflection in opioid prescriptions dispensed occurred post-mandate implementation. MethodsInterrupted Time Series Analysis (ITSA) design was used to examine whether the level (immediate impact) and trend in opioid prescribing changed significantly after the PDMP use mandate was implemented. We used a novel Change Point Analysis (CPA) approach to test the hypothesis i.e., identify if and when a change or inflection in opioid dispensing trend occurred after implementation of the PDMP use mandate. ResultsITSA model results showed a significant drop in opioid prescriptions dispensed (p < 0.05) immediately after the mandate implementation (i.e., April 2017). Results of the CPA identified a significant inflection in opioid prescriptions dispensed starting January 2019 (21-months post-policy implementation). An ITSA model using the inflection point as an interruption showed that the trend in opioid prescriptions dispensed became flatter after the inflection point, suggesting normalization. ConclusionUsing a novel CPA approach, the findings showed an inflection in the trend in opioid prescriptions dispensed post-PDMP use mandate implementation, implying that most of the avoidable prescribing likely was curtailed. The results suggest that the patient information presumably accessed from the WI PDMP interface was useful in helping prescribers to make an informed clinical decision about opioid prescribing.

Opioid Prescription Trends for Isolated Diaphyseal Femur Fractures in Pediatric Patients

Purpose: Despite the ongoing opioid epidemic, there is a lack of research on narcotic prescribing in the pediatric orthopaedic population. The Pediatric Orthopaedic Society of North America (POSNA) therefore published a survey on pain management to provide recommendations for opioid dosing. The goal of this study was to characterize opioid prescribing patterns for pediatric femur fractures in the context of the opioid epidemic and emerging national studies/guidelines.Methods: A retrospective review of 128 pediatric patients (age < 16) with isolated diaphyseal femur fractures was conducted between 2003-2019 at a level I pediatric trauma center. Comparison groups included before distribution of the POSNA survey (pre-POSNA = 01/01/2016 or earlier, N = 85) and after the survey (post-POSNA, N = 43).Results: Median total hospital postoperative opioids prescribed was 27.2 morphine milligram equivalents (MME). The two groups differed in age (pre-POSNA = 9.0 years, post-POSNA = 3.7 years, P = 0.0381), hospital length of stay (LOS) (pre-POSNA = 2 days, post-POSNA = 1 day, P < 0.0001), and procedural incision required for fracture reduction (pre-POSNA = 28.3%, post-POSNA = 58.1%, P = 0.0019). Adjusted postoperative opioid dosing was significantly lower post-POSNA (median reduction of 18.351 MME per year, P = 0.0408).Conclusions: The period following the POSNA survey was associated with a significant decline in postoperative narcotic prescriptions for pediatric femur fractures. The timing of the survey likely represents an increased concern for pediatric opioid use and a shift in clinical practice. Further work is needed to optimize injury and patient-specific narcotic prescribing.Level of Evidence: Therapeutic Level III Key Concepts•The 2016 POSNA survey identified a lack of consensus on opioid prescribing practices for common orthopaedic procedures in the United States.•The 2016 POSNA survey and subsequent 2019 published narcotic prescription recommendations represent a shift in the specialty of orthopaedic surgery regarding opioid usage in the pediatric population.•Postoperative morphine milligram equivalents significantly decreased for the treatment of pediatric diaphyseal femur fractures at a single-level I pediatric trauma center following administration of the 2016 POSNA survey.

Opioid prescriptions at the point of surgery, bone metastasis, or death among patients with breast cancer in Japanese acute care hospitals: a claims-based, retrospective, longitudinal study

PurposeBreast cancer is the most common cancer among Japanese women and often yields a better prognosis than other cancers. However, few studies have been conducted on pain control using opioids in Japan. In this study, we aimed to examine actual opioid use among breast cancer patients.MethodsBreast cancer patients were defined as female patients with a first breast cancer diagnosis during the observational period in an acute care hospital database (April 2008 − February 2020). We examined the percentage of patients prescribed opioids, the opioid amount per patient, and the opioid dosage per day around surgery, bone metastasis diagnosis, or death.ResultsOverall, 217,722 breast cancer patients were identified. The percentage of patients prescribed opioids and the average amount of opioids per patient were highest in the month of surgery, 78% and 27 morphine milligram equivalents (MMEs), respectively. The average opioid dosage increased with time after surgery from 19 to 28 MMEs. Around bone metastasis, the percentage of patients prescribed opioids and the average opioid amount per patient peaked one month after the diagnosis, 31% and 371 MMEs, respectively. The average opioid dosage gradually increased from 22 to 35 MMEs in succeeding days after a bone metastasis diagnosis. The percentage of patients prescribed opioids and the average opioid amount per patient increased as the month of death approached.ConclusionWe investigated opioid prescription trends around clinical events in breast cancer patients on a large scale in Japan. These results may be useful to control cancer pain among breast cancer patients.

Opioid Prescription Patterns 90 Days After Arthroscopic Rotator Cuff Repair: A 10-Year National Database Analysis.

Arthroscopic rotator cuff repair (ARCR) is a common procedure that typically requires opioid prescription for postoperative pain management. To investigate the current prescription patterns and factors influencing 90-day postoperative opioid prescription trends for opioid-naïve patients who underwent ARCR. Case series; Level of evidence, 4. Opioid-naïve adult patients who underwent ARCR between January 2010 and September 2020 and had a record of opioid prescriptions during the 90-day postoperative period were identified in the PearlDiver Mariner91 national administrative database. Exclusions included patients with prior shoulder procedures, a history of chronic pain, and opioid prescription records dated earlier than 4 weeks before surgery. Covariates included age group, sex, Elixhauser Comorbidity Index, and prescriber specialty (orthopaedic or nonorthopaedic). The primary outcome-90-day postoperative morphine milligram equivalents (MMEs) prescribed per patient-was compared using univariate and multivariate regression analyses, and 90-day postoperative opioid prescription trends over the 10-year study period were analyzed with linear regression. In total, 55,345 ARCR cases were identified. The mean ± SD amount prescribed within the first 90 days was 742.4 ± 256.5 MMEs, and the median was 487.5 MMEs. Multivariate linear regression analysis predicted higher 90-day postoperative MMEs for female patients and younger patients (P < .01 for both). From 2010 to 2020, there was a 66% decrease in mean MME prescribed per patient (▵ = 660.4 MME; P < .01), with a mean reduction of 55.1 MME per patient per year. In 2020, the mean 90-day postoperative amount prescribed was 341.1 MME, which is equivalent to 51 tablets of 5-mg oxycodone (Percocet). Female sex and younger age were predictors of more MME being prescribed after ARCR. While opioid prescriptions following ARCR have substantially decreased over the past decade, the amount prescribed warrants further attention.

Retrospectively evaluating trends in opioid prescriptions and medication-assisted treatment in a mid-Michigan region.

To evaluate opioid prescribing and monitoring trends for musculoskeletal (MSK) conditions and the use of medication-assisted treatment (MAT) for opioid-related disorders in mid-Michigan. Retrospective chart review of 500 randomly selected charts coded for MSK conditions and opioid-related disorders based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes during the time frame of January 1 to June 30, 2019. Data were compared to baseline data collected in a previous 2016 study to evaluate prescribing trends. Outpatient clinics and emergency departments. Variables included prescription of opioid, nonopioid, use of prescription monitoring such as assessing urine drug screens (UDSs), a Prescription Drug Monitoring Program (PDMP), pain agreements, prescription of MAT, and sociodemographic factors. 31.3 percent of patients in 2019 had a new or current opioid prescription, which is a significant decrease compared to opioid prescriptions in 2016 (65.7 percent) (p = 0.001). Monitoring of opioid prescribing using PDMP and pain agreements increased, whereas UDS monitoring remained low. MAT prescribing for patients with opioid use disorder in 2019 was 31.4 percent. State-sponsored insurance was associated with a higher odds of using PDMP and pain agreements with an odds ratio (OR) of 1.72 (0.97, 3.13), while alcohol misuse had a lower odds of using PDMP (OR 0.40). Opioid prescribing guidelines have been effective in reducing opioid prescribing and increasing opioid prescription monitoring. MAT prescribing is low in 2019 and does not reflect a declining trend of opioid prescriptions during a public health crisis.

Opioid prescription trends among American Head and Neck Society fellowship graduates.

Opioids are commonly used to manage the pain of head and neck (HN) cancer patients. Retrospective cohort of graduates from American Head and Neck Society accredited fellowships from 1997 to 2018. The Center for Medicare and Medicaid Services Part D Provider Utilization and Payment database 2014-2019 was cross-referenced with provider names to identify opioid prescription trends. From 2014 to 2019, there was no significant difference in the average number of opioid beneficiaries per provider (18.02 vs. 18.10, p=0.586) or opioid claims per provider (28.06 vs. 26.73, p=0.708). The average total opioid day supply per beneficiary declined from 11.09 to 7.05 days from 2014 to 2019 (p < 0.001). In 2019, providers in the Northeast had the lowest prescribed opioid day supply (3.67 days) compared to those from the South who had the highest (10.32 days). Opioid prescription length has significantly declined among HN surgeons, with variations across geographic regions.

Changes in postoperative opioid prescribing across three diverse healthcare systems, 2010-2020.

The opioid crisis brought scrutiny to opioid prescribing. Understanding how opioid prescribing patterns and corresponding patient outcomes changed during the epidemic is essential for future targeted policies. Many studies attempt to model trends in opioid prescriptions therefore understanding the temporal shift in opioid prescribing patterns across populations is necessary. This study characterized postoperative opioid prescribing patterns across different populations, 2010-2020. Administrative data from Veteran Health Administration (VHA), six Medicaid state programs and an Academic Medical Center (AMC). Surgeries were identified using the Clinical Classifications Software. Trends in average daily discharge Morphine Milligram Equivalent (MME), postoperative pain and subsequent opioid prescription were compared using regression and likelihood ratio test statistics. The cohorts included 595,106 patients, with populations that varied considerably in demographics. Over the study period, MME decreased significantly at VHA (37.5-30.1; p = 0.002) and Medicaid (41.6-31.3; p = 0.019), and increased at AMC (36.9-41.7; p < 0.001). Persistent opioid users decreased after 2015 in VHA (p < 0.001) and Medicaid (p = 0.002) and increase at the AMC (p = 0.003), although a low rate was maintained. Average postoperative pain scores remained constant over the study period. VHA and Medicaid programs decreased opioid prescribing over the past decade, with differing response times and rates. In 2020, these systems achieved comparable opioid prescribing patterns and outcomes despite having very different populations. Acknowledging and incorporating these temporal distribution shifts into data learning models is essential for robust and generalizable models.

The Effect of Online Prescription Drug Monitoring on Opioid Prescription Habits After Elective Single-level Lumbar Fusion.

The United States opioid epidemic is a well-documented crisis stemming from increased prescriptions of narcotics. Online prescription drug monitoring programs (PDMPs) are a potential resource to mitigate narcotic misuse by tracking controlled substance prescriptions. Therefore, the purpose of this study was to evaluate opioid prescription trends after implementation of an online PDMP in patients who underwent single-level lumbar fusion. Patients who underwent a single-level lumbar fusion between August 27, 2017, and August 31, 2020, were identified and placed categorically into one of two cohorts: an "early adoption" cohort, September 1, 2017, to August 31, 2018, and a "late adoption" cohort, September 1, 2019, to August 31, 2020. This allowed for a 1-year washout period after Pennsylvania PDMP implementation on August 26, 2016. Opioid use data were obtained by searching for each patient in the state government's online PDMP and recording data from the year before and the year after the patient's procedure. No significant difference was observed in preoperative opioid prescriptions between the early and late adoption cohorts. The late adoption group independently predicted decreased postoperative opioid prescriptions (β, 0.78; 95% confidence interval [CI], 0.65 to 0.93; P = 0.007), opioid prescribers (β, 0.81; 95% CI, 0.72 to 0.90; P < 0.001), pharmacies used (β, 0.90; 95% CI, 0.83 to 0.97; P = 0.006), opioid pills (β, 0.61; 95% CI, 0.50 to 0.74; P < 0.001), days of opioid prescription (β, 0.57; 95% CI, 0.45 to 0.72; P < 0.001), and morphine milligram equivalents prescribed (β, 0.53; 95% CI, 0.43 to 0.66; P < 0.001). PDMP implementation was associated with decreased postoperative opioid prescription patterns but not preoperative opioid prescribing behaviors. 4.

Opioid prescribing patterns among oculofacial plastic surgeons.

Oculofacial plastic surgeons (OPS) prescribe narcotic pain prescriptions at a rate four times higher than that of other ophthalmologists. We conducted a cross-sectional survey to understand trends in opioid prescriptions among oculofacial plastic surgeons after common oculoplastic surgeries. This cross-sectional survey was sent to OPS in the USA between June 19, 2020 and December 1, 2020. Participants were asked about their training and practice as well as their top two choices for post-operative pain management both overall and for seven common oculoplastic surgeries. Fisher's exact and chi-square tests were performed to analyze relationships between categorical variables. The two most common opioid medications, in percentage of respondents (n = 82), prescribed overall by OPS were hydrocodone-acetaminophen (35%) and tramadol (21%). Between OPS completed training before 1990(16%) and those who completed training from 1991 to 2000 (12%), the latter cohort is 4.9 times more likely to prescribe opioids overall ([95% CI = 1.3-15.4], p = .01). Additionally, OPS who are currently practicing in the Southeast USA are 4.2 times more likely to prescribe opioids overall than those practicing in the Northeast USA ([95% CI: 1.4-12.8], p = .02). This study has helped identify patterns in opioid prescribing behavior among OPS based on demographic information and common oculoplastic surgeries. This knowledge will help bring awareness of prescribing behavior to the oculoplastics community and identify areas of improvement to reduce opioid prescriptions. Kindly check and confirm the OD and ON has been correctly identified in 2nd affiliationYes.

Shifting practice in pediatric prescription opioid use in the emergency department for fractures

ObjectivesJudicious opioid use is important for balancing patient comfort and safety. Although opioid use is well studied in adult populations, pediatric opioid prescription practices are less understood and there are very few guidelines regarding its usage. The purpose of this study was to investigate pediatric opioid prescription trends by emergency medicine physicians over the last ten years, including assessing proxies for the adequacy of pain control and risk of any opioid-related adverse events including overdose. MethodsA retrospective analysis was performed of all patients age 0 to 18 who presented to an urban county hospital emergency department (ED) between 2007 and 2017 for acute fracture care. Data collected included age, opioids given in the ED, opioid prescriptions from the ED, adverse events, and secondary opioid prescriptions. Opioid prescription quantities were assessed in morphine equivalents (Meqs). ResultsOut of 4713 patients diagnosed with acute fracture, opioid prescriptions from the ED were given to 1772 patients (37.6%), with a mean quantity of 107.0 Meqs (SD = 69.1). Over the ten-year period studied, prescription rates declined from 54.8% in 2007 to 13.6% in 2017. Although 201 (4.3%) fracture patients had a second fracture-related ED visit, only 27 visits (0.57%) were for inadequate pain control, with no significant differences in year-to-year analysis. During the ten-year study period, there were zero opioid overdoses reported among pediatric fracture patients. ConclusionsA major shift has occurred in the last ten years, as emergency medicine physicians now favor non-opioid pain management regimens over opioids for the majority of pediatric fracture patients. There was no increase in the rate of inadequate pain control requiring a return to the ED, even as opioid prescription rates declined during the study period.

MP26-12 CHANGING NATIONAL TRENDS IN OPIOID PRESCRIPTIONS FOR PAIN MANAGEMENT IN ACUTE KIDNEY STONE DISEASE

You have accessJournal of UrologyCME1 May 2022MP26-12 CHANGING NATIONAL TRENDS IN OPIOID PRESCRIPTIONS FOR PAIN MANAGEMENT IN ACUTE KIDNEY STONE DISEASE Chinmayee Katragadda, Alexis Steinmetz, Alexander Cranwell, and Rajat Jain Chinmayee KatragaddaChinmayee Katragadda More articles by this author , Alexis SteinmetzAlexis Steinmetz More articles by this author , Alexander CranwellAlexander Cranwell More articles by this author , and Rajat JainRajat Jain More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002569.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Deaths from opioid-related overdose contributed to the decline in life expectancy seen in the US from 2014-2018 and surpassed deaths from automobile accidents. Urologic surgery and disease, including benign conditions such as kidney stone disease (KSD), are a significant source of opioid prescriptions. We investigated prescription patterns for opioids and non-opioids for KSD in the Emergency Department (ED) setting. These data provide important information as urologists seek opioid sparing approaches and effective alternative therapies for the KSD population. METHODS: The US National Hospital Ambulatory Medical Care Survey (NHMACS) was queried for ED visits for KSD from 2012 to 2017. Adult patients with KSD-related diagnoses that visited the ED were identified using International Classification of Diseases codes. Prescription rates of opioids and non-opioids were analyzed with respect to age, sex, region, race/ethnicity, and payer type. Survey weighted chi-square and logistic regression, and adjusted odds ratios were used to analyze associations. RESULTS: Six million KSD-related ED visits were identified. The percentage of patients receiving opioid prescriptions decreased from 33% to 16% from 2012-2017 (p-trend <0.001) while non-opioid prescriptions rose from 67% to 84% in that same time period (p-trend <0.02). Compared to 2012, the odds of receiving an opioid prescription decreased significantly in 2016 and 2017 (OR 0.27, p=0.01 and OR 0.12, p<0.0001, respectively). There was a concurrent increase in the odds of receiving a non-opioid prescription in 2016 and 2017 (OR 2.02, p=0.03 and OR 2.63, p=0.01 respectively). Payer type, episode of care and gender were not associated with type of prescription. CONCLUSIONS: The dramatic decrease in opioid prescriptions for kidney stone disease has been accompanied by a concomitant rise in non-opioid prescriptions. This represents a fundamental shift in the management of pain in acute kidney stone disease which is reflective of the nationwide public health effort to curb the opioid epidemic. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e443 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chinmayee Katragadda More articles by this author Alexis Steinmetz More articles by this author Alexander Cranwell More articles by this author Rajat Jain More articles by this author Expand All Advertisement PDF DownloadLoading ...

Trends in Opioid Prescribing by General Dentists and Dental Specialists in the U.S., 2012–2019

Evidence suggests that U.S. dentists prescribe opioids excessively. There are limited national data on recent trends in opioid prescriptions by U.S. dentists. In this study, we examined trends in opioid prescribing by general dentists and dental specialists in the U.S. from 2012 to 2019. Dispensed prescriptions for oral opioid analgesics written by dentists were identified from IQVIA Longitudinal Prescription Data from January 2012 through December 2019. Autoregressive integrated moving average and joinpoint regression models described monthly population-based prescribing rates (prescriptions/100,000 individuals), dentist-based prescribing rates (prescriptions/1,000 dentists), and opioid dosages (mean daily morphine milligram equivalents/day). All analyses were performed in 2020. Over the 8 years, dentists prescribed >87.2 million opioid prescriptions. Population- and dentist-based prescribing rates declined monthly by -1.97 prescriptions/100,000 individuals (95% CI= -9.98, -0.97) and -39.12 prescriptions/1,000 dentists (95% CI= -58.63, -17.65), respectively. Opioid dosages declined monthly by -0.08 morphine milligram equivalents/day (95% CI= -0.13, -0.04). Joinpoint regression identified 4 timepoints (February 2016, May 2017, December 2018, and March 2019) at which monthly prescribing rate trends were often decreasing in greater magnitude than those in the previous time segment. Following national trends, dentists became more conservative in prescribing opioids. A greater magnitude of decline occurred post 2016 following the implementation of strategies aimed to further regulate opioid prescribing. Understanding the factors that influence prescribing trends can aid in development of tailored resources to encourage and support a conservative approach by dentists, to prescribing opioids.

Recent trends in opioid prescriptions in Korea from 2002 to 2015 based on the Korean NHIS-NSC cohort.

OBJECTIVESOpioids are prescribed to treat moderate to severe pain. We investigated recent trends in opioid (morphine, oxycodone, fentanyl, and hydromorphone) prescriptions using data from the Korean National Health Insurance Service-National Sample Cohort between 2002 and 2015.METHODSThe morphine milligram equivalent (MME) was calculated to standardize the relative potency of opioids. The number (cases) or amount (MME) of annual opioid prescriptions per 10,000 registrants was computed to analyze trends in opioid prescriptions after age standardization. Joinpoint regression analysis was conducted to calculate the annual percentage change and average annual percentage change (AAPC).RESULTSThe number (cases) of prescriptions per 10,000 registrants increased from 0.07 in 2002 to 41.23 in 2015 (AAPC, 76.0%; 95% confidence interval [CI], 61.6 to 91.7). The MME per 10,000 registrants increased from 15.06 in 2002 to 40,727.80 in 2015 (AAPC, 103.0%; 95% CI, 78.2 to 131.3). The highest AAPC of prescriptions and MME per 10,000 registrants were observed in the elderly (60-69 years) and in patients treated at general hospitals. Fentanyl prescriptions increased most rapidly among the 4 opioids.CONCLUSIONSConsumption of opioids greatly increased in Korea over the 14-year study period.

National Trends and Prescription Patterns in Opiate Analgesia for Urolithiasis Presenting to Emergency Departments: Analysis of the National Hospital Ambulatory Medical Care Survey, 2006-2018

To analyze the National Hospital Ambulatory Medical Care Survey (NHAMCS) database to determine geographic and temporal trends, as well as variables associated with the likelihood of receiving an opioid prescription for urolithiasis in United States (US) emergency departments (EDs). All ED visits for urolithiasis between 2006 and 2018 in the NHAMCS database were analyzed. Age, race/ethnicity, insurance status, ED provider credentials, geographic region, and urban vs rural hospital status were extracted. Linear regression was used to examine overall/regional trends in opioid prescriptions over time. Logistic regression was used to estimate factors associated with higher odds of receiving opioids. Fourteen million visits were analyzed, of which, 79.1% (11.0 million) received an opioid prescription. From 2014 to 2018 there was a decline of 3.65%/year of the proportion of visits receiving an opioid prescription (R2 = 0.86, P = .008). Non-Hispanic Black race was associated with a lower chance of receiving opioid prescription (OR = 0.57, P = .02) compared to Non-Hispanic Whites (NHW). Midwestern hospitals had higher odds of opioid prescription compared to the Northeast (OR = 2.05, P = .006). Rural hospitals had lower odds of opioid prescription compared to urban hospitals (OR = 0.62, P = .02). Opioid prescriptions for patients presenting with urolithiasis to the ED have steadily declined from 2014 to 2018, except in the Midwest. NHW race, Midwest region, and urban EDs increase the likelihood of receiving opioids. Continued efforts encouraging non-opioid alternatives for urolithiasis are essential, specifically in Midwestern EDs, to mitigate the ongoing opioid epidemic in the US.

Opioid Analgesic Prescription in French Children: A National Population-Based Study.

Codeine use was restricted in 2013 and is currently contraindicated for children below the age of 12 years. We examined how the prescription of opioid analgesics in children in France evolved between 2012 and 2018. Our population-based study from the SNIIRAM database (National System of Health Insurance Inter-Regime Information) was designed to determine trends in opioid prescription from 2012 to 2018 in all French children. The number of children who received at least one opioid prescription gradually declined from 452,665 in 2012 (347.5 children per 10,000) to 169,338 in 2018 (130.3 children per 10,000). This decrease was especially marked for codeine (36 children per 10,000 in 2018 vs. 308.5 children per 10,000 in 2012), whereas the number of tramadol prescriptions increased by 171% in 2018 (94.6 children per 10,000). Despite the increase, strong opioids still formed only a small proportion of prescriptions (2.6 children per 10,000 given opioids in 2018). Overall opioid prescriptions in French children dramatically decreased between 2012 and 2018, probably owing to restrictions on the use of codeine. Codeine has been partly replaced by tramadol. Morphine is still probably underused. This suggests that opioids are being used less often for pain management in children.

Substitution of Nonpharmacologic Therapy With Opioid Prescribing for Pain During the COVID-19 Pandemic

During the pandemic, access to medical care unrelated to COVID-19 was limited because of concerns about viral spread and corresponding policies. It is critical to assess how these conditions affected modes of pain treatment, given the addiction risks of prescription opioids. To assess the trends in opioid prescription and nonpharmacologic therapy (ie, physical therapy and complementary medicine) for pain management during the COVID-19 pandemic in 2020 compared with the patterns in 2019. This retrospective, cross-sectional study used weekly claims data from 24 million US patients in a nationwide commercial insurance database (Optum's deidentified Clinformatics Data Mart Database) from January 1, 2019, to September 31, 2020. Among patients with diagnoses of limb, extremity, or joint pain, back pain, and neck pain for each week, patterns of treatment use were identified and evaluated. Data analysis was performed from April 1, 2021, to September 31, 2021. The main outcomes of interest were weekly rates of opioid prescriptions, the strength and duration of related opioid prescriptions, and the use of nonpharmacologic therapy. Transition rates between different treatment options before the outbreak and during the early months of the pandemic were also assessed. A total of 21 430 339 patients (mean [SD] age, 48.6 [24.0] years; 10 960 507 [51.1%] female; 909 061 [4.2%] Asian, 1 688 690 [7.9%] Black, 2 276 075 [10.6%] Hispanic, 11 192 789 [52.2%] White, and 5 363 724 [25.0%] unknown) were enrolled during the first 3 quarters in 2019 and 20 759 788 (mean [SD] age, 47.0 [23.8] years; 10 695 690 [51.5%] female; 798 037 [3.8%] Asian; 1 508 023 [7.3%] Black, 1 976 248 [9.5%] Hispanic, 10 059 597 [48.5%] White, and 6 417 883 [30.9%] unknown) in the first 3 quarters of 2020. During the COVID-19 pandemic, the proportion of patients receiving a pain diagnosis was smaller than that for the same period in 2019 (mean difference, -15.9%; 95% CI, -16.1% to -15.8%). Patients with pain were more likely to receive opioids (mean difference, 3.5%; 95% CI, 3.3%-3.7%) and less likely to receive nonpharmacologic therapy (mean difference, -6.0%; 95% CI, -6.3% to -5.8%), and opioid prescriptions were longer and more potent during the early pandemic in 2020 relative to 2019 (mean difference, 1.07 days; 95% CI, 1.02-1.17 days; mean difference, 0.96 morphine milligram equivalents; 95% CI, 0.76-1.20). Analysis of individuals' transitions between treatment options for pain found that patients were more likely to transition out of nonpharmacologic therapy, replacing it with opioid prescriptions for pain management during the COVID-19 pandemic than in the year before. Nonpharmacologic therapy is a benign treatment for pain often recommended instead of opioid therapy. The decrease in nonpharmacologic therapy and increase in opioid prescription during the COVID-19 pandemic found in this cross-sectional study, especially given longer days of prescription and more potent doses, may exacerbate the US opioid epidemic. These findings suggest that it is imperative to investigate the implications of limited medical access on treatment substitution, which may increase patient risk, and implement policies and guidelines to prevent those substitutions.