Conversion to Persistent or High-Risk Opioid Use After a New Prescription From the Emergency Department: Evidence From Washington Medicaid Beneficiaries - 25/10/19
, Nicoleta Lupulescu-Mann, MS c, Christina J. Charlesworth, MPH c, Hyunjee Kim, PhD c, Benjamin C. Sun, MD, MPP a, b, cAbstract |
Study objective |
We describe the overall risk and factors associated with transitioning to persistent opioid or high-risk use after an initial emergency department (ED) opioid prescription.
Methods |
A retrospective cohort study of Washington Medicaid beneficiaries was performed with linked Medicaid and prescription drug monitoring program files. We identified adults who had no record of opioid prescriptions in the previous 12 months, and who filled a new opioid prescription within 1 day of an ED discharge in 2014. We assessed the risk of persistent opioid use or high-risk prescription fills within 12 months after the index visit. Logistic regression was used to assess the association between pertinent variables and conversion to persistent or high-risk use.
Results |
Among 202,807 index ED visits, 23,381 resulted in a new opioid prescription. Of these, 13.7% led to persistent or high-risk opioid prescription fills within 12 months compared with 3.2% for patients who received no opioids at the index visit. Factors associated with increased likelihood of persistent opioid or high-risk prescription fills included a history of skeletal or connective-tissue disorder; neck, back, or dental pain; and a history of prescribed benzodiazepines. The highest conversion rates (37.3%) were observed among visits in which greater than or equal to 350 morphine milligram equivalents were prescribed. Conversion rates remained greater than 10% even among visits resulting in lower-dose opioid prescriptions.
Conclusion |
Medicaid recipients are at moderate risk for conversion to persistent or high-risk opioid use after a new ED prescription. Longer or higher-dose prescriptions are associated with increased risk for conversion; however, even visits that lead to guideline-concordant prescriptions bear some risk for long-term or high-risk use.
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| Please see page 612 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Donald M. Yealy, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: ZFM and BS conceived the study and obtained research funding. ZFM, NLM, CJC, HK, and BS conceived of the analysis plan. BS and CJC supervised the data collection, data management, and quality control. NLM, CDC, and HK provided statistical advice and analyzed the data. ZFM and BS drafted the manuscript and all authors contributed substantially to its revision. ZFM takes responsibility for the manuscript as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This study was supported by National Institutes of Health (NIH) grants R01DA036522 (Sun) and P30DA040500 (Meisel). This study was also supported by the Patient Centered Outcomes Research Institute (PCORI) DR-1511-33496 (Meisel) and the US Centers for Disease Control R49CE00247 (Meisel). |
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| The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the article. The contents do not necessarily represent the official views of the NIH. |
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Vol 74 - N° 5
P. 611-621 - novembre 2019 Retour au numéro
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