Association between initial opioid prescription diagnosis type and subsequent chronic prescription opioid use in Rhode Island: a population-based cohort study

• Published in: BMJ open Vol. 12; no. 1; p. e050540
• Main Authors: Hallowell, Benjamin D, Chambers, Laura C, Barre, Luke, Diao, Nancy, Onyejekwe, Collette, Banks, Alexandra, Bratberg, Jeffery, Weidele, Heidi, Viner-Brown, Samara, McDonald, James
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 06.01.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Analgesics, Opioid - therapeutic use; Bias; Chronic illnesses; clinical pharmacology; Codes; Cohort analysis; Cohort Studies; Controlled substances; Drug Prescriptions; Drug stores; epidemiology; Humans; Medicaid; Medical diagnosis; Medicare; Morphine; Narcotics; Pain; pain management; Pharmacy; Population; Population-based studies; Practice Patterns, Physicians; Prescription drugs; Public Health; Retrospective Studies; Rhode Island - epidemiology; Rhode Island; United States > US; epidemiology; clinical pharmacology; pain management; public health
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-050540

ObjectiveTo identify initial diagnoses associated with elevated risk of chronic prescription opioid use.DesignPopulation-based, retrospective cohort study.SettingState of Rhode Island.ParticipantsRhode Island residents with an initial opioid prescription dispensed between 1 April 2019 and 31 March 2020.Primary outcome measureSubsequent chronic prescription opioid use, defined as receiving 60 or more days’ supply of opioids in the 90 days following an initial opioid prescription.ResultsAmong the 87 055 patients with an initial opioid prescription, 3199 (3.7%) subsequently became chronic users. Patients who become chronic users tended to receive a longer days’ supply, greater quantity dispensed, but a lower morphine milligram equivalents on the initial opioid prescription. Patients prescribed an initial opioid prescription for diseases of the musculoskeletal system and connective tissue (adjusted OR (aOR): 5.9, 95% CI: 4.7 to 7.6), diseases of the nervous system (aOR: 6.3, 95% CI: 4.9 to 8.0) and neoplasms (aOR: 5.6, 95% CI: 4.2 to 7.5) had higher odds of subsequent chronic prescription opioid use, compared with a referent group that included all diagnosis types with fewer than 15 chronic opioid users, after adjusting for confounders.ConclusionsBy focusing interventions and prescribing guidelines on specific types of diagnoses that carry a high risk of chronic prescription opioid use and diagnoses that would benefit equally or more from alternative management approaches, states and healthcare organisations may more efficiently decrease inappropriate opioid prescribing while improving the quality of patient care.