Dataset Information

Low use of opioid risk reduction strategies in primary care even for high risk patients with chronic pain.

ABSTRACT:

Background/objective

Experts recommend close oversight of patients receiving opioid analgesics for chronic non-cancer pain (CNCP), especially those at increased risk of misuse. We hypothesized that physicians employ opioid risk reduction strategies more frequently in higher risk patients.

Design

Retrospective cohort using electronic medical records.

Participants

Patients on long-term opioids (?3 monthly prescriptions in 6 months) treated for CNCP in eight primary care practices.

Methods

We examined three risk reduction strategies: (1) any urine drug test; (2) regular office visits (at least once per 6 months and within 30 days of modifying opioid treatment); and (3) restricted early refills (one or fewer opioid refills more than a week early). Risk factors for opioid misuse included: age <45 years old, drug or alcohol use disorder, tobacco use, or mental health disorder. Associations of risk factors with each outcome were assessed in non-linear mixed effects models adjusting for patient clustering within physicians, demographics and clinical factors.

Main results

Of 1,612 patients, 8.0% had urine drug testing, 49.8% visited the office regularly, and 76.6% received restricted (one or fewer) early refills. Patient risk factors were: age <45 (29%), drug use disorder (7.6%), alcohol use disorder (4.5%), tobacco use (16.1%), and mental health disorder (48.4%). Adjusted odds ratios (AOR) of urine drug testing were significantly increased for patients with a drug use disorder (3.18; CI 1.94, 5.21) or a mental health disorder (1.73; CI 1.14, 2.65). However, the AOR for restricted early refills was significantly decreased for patients with a drug use disorder (0.56; CI 0.34, 0.92). After adjustment, no risk factor was significantly associated with regular office visits. An increasing number of risk factors was positively associated with urine drug testing (p?ConclusionPrimary care physicians' adoption of opioid risk reduction strategies is limited, even among patients at increased risk of misuse.

SUBMITTER: Starrels JL

PROVIDER: S-EPMC3157518 | biostudies-literature | 2011 Sep

REPOSITORIES: biostudies-literature

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Publications

Low use of opioid risk reduction strategies in primary care even for high risk patients with chronic pain.

Starrels Joanna L JL Becker William C WC Weiner Mark G MG Li Xuan X Heo Moonseong M Turner Barbara J BJ

Journal of general internal medicine 20110224 9

<h4>Background/objective</h4>Experts recommend close oversight of patients receiving opioid analgesics for chronic non-cancer pain (CNCP), especially those at increased risk of misuse. We hypothesized that physicians employ opioid risk reduction strategies more frequently in higher risk patients.<h4>Design</h4>Retrospective cohort using electronic medical records.<h4>Participants</h4>Patients on long-term opioids (≥3 monthly prescriptions in 6 months) treated for CNCP in eight primary care pract ...[more]

PMID: 21347877

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Project description:OBJECTIVE:To determine the association of medical marijuana legalization with prescription opioid utilization. METHODS:A 10% sample of a nationally representative database of commercially insured population was used to gather information on opioid use, chronic opioid use, and high-risk opioid use for the years 2006-2014. Adults with pharmacy and medical benefits for the entire calendar year were included in the population for that year. Multilevel logistic regression analysis, controlling for patient, person-year, and state-level factors, were used to determine the impact of medical marijuana legalization on the three opioid use measures. Sub-group analysis among cancer-free adults and cancer-free adults with at least one chronic non-cancer pain condition in the particular year were conducted. Alternate regression models were used to test the robustness of our results including a fixed effects model, an alternate definition for start date for medical marijuana legalization, a person-level analysis, and a falsification test. RESULTS:The final sample included a total of 4,840,562 persons translating into 15,705,562 person years. Medical marijuana legalization was found to be associated with a lower odds of any opioid use: OR = 0.95 (0.94-0.96), chronic opioid use: OR = 0.93 (0.91-0.95), and high-risk opioid use: OR = 0.96 (0.94-0.98). The findings were similar in both the sub-group analyses and all the sensitivity analyses. The falsification tests showed no association between medical marijuana legalization and prescriptions for antihyperlipidemics (OR = 1.00; CI 0.99-1.01) or antihypertensives (OR = 1.00; CI 0.99-1.01). CONCLUSIONS:In states where marijuana is available through medical channels, a modestly lower rate of opioid and high-risk opioid prescribing was observed. Policy makers could consider medical marijuana legalization as a tool that may modestly reduce chronic and high-risk opioid use. However, further research assessing risk versus benefits of medical marijuana legalization and head to head comparisons of marijuana versus opioids for pain management is required.

Dataset Information

Low use of opioid risk reduction strategies in primary care even for high risk patients with chronic pain.

Background/objective

Design

Participants

Methods

Main results

Publications

Low use of opioid risk reduction strategies in primary care even for high risk patients with chronic pain.

Similar Datasets

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