Clinical research studyA Tool to Assess Risk of De Novo Opioid Abuse or Dependence
Section snippets
Materials and Methods
We used de-identified (in accordance with Health Insurance Portability and Accountability Act requirements) pharmacy and medical claims data from a pharmacy benefit manager (Express Scripts) from October 1, 2009, to September 30, 2013. These data include health insurance claims (inpatient/outpatient medical and outpatient pharmacy) and enrollment data from large employers and health plans across the United States. This study included patients aged 18 years or older as of the index opioid claim
Results
The derivation cohort included 694,851 patients, of whom 2067 (0.3%) were opioid abusers/dependents. They were significantly younger (Table 2). There were more chronic opioid users (55.8% vs 10.4%) in the group that developed abuse or dependence.
Clinical factors significantly varied between the 2 groups of patients. Opioid abusers/dependents had a higher proportion of mental illness (52.1% vs 14.9%) and nonopioid substance abuse (4.1% vs 0.2%), and nondependent alcohol abuse (4.0% vs 0.5%)
Discussion
This study identified 12 patient characteristics that predict increased risk of de novo abuse or dependence in opioid users. The strongest predictors were chronic use, mental illness, nonopioid substance use, alcohol abuse, high morphine equivalent dose per day, younger age, and male gender. These effects were in the direction as hypothesized. In this study, the relationships between the distance from patient to prescriber and being a chronic immediate-release user to the odds of developing
Conclusions
In light of the opioid abuse epidemic, the findings of this study warrant updating tools that estimate the risk for abuse or dependence. We recommend incorporating factors found in a prescription drug monitoring program into a patient's risk analysis. We found that risk factors for a patient being diagnosed with opioid abuse or dependence are younger age; being a chronic opioid user; histories of mental illness, nonopioid substance abuse, and alcohol abuse; being a high morphine equivalent dose
Acknowledgments
H. M. Dinesh, MS, Genpact, contributed to data collection. From Express Scripts, Craig Reno, BS, MBA, provided clinical expertise on the analysis, Ria Westergaard, PharmD, provided clinical expertise on the analysis. In addition to the authors, Ruth Martinez, RPh, contributed to writing and editing the manuscript.
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Cited by (0)
Funding: TC receives support from an unrestricted grant from the Foundation for Barnes-Jewish Hospital. RI and AB receive salary support from Express Scripts, an independent pharmacy benefits manager. DT also received salary support from Express Scripts at the time the study was conducted. BFG receives support from Washington University Institute of Clinical and Translational Sciences Grant UL1 TR000448 from the National Institutes of Health.
Conflict of Interest: None.
Authorship: All authors had access to the data and played a role in writing this manuscript.