Assessment of Potentially Inappropriate Prescribing of Opioid Analgesics Requiring Prior Opioid Tolerance
Opioid-tolerant only (OTO) medications, such as transmucosal immediate-release fentanyl products and certain extended-release opioid analgesics, require prior opioid tolerance for safe use, as patients without tolerance may be at increased risk of overdose. Studies using insurance claims have found...
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| creator | Jeffery, Molly Moore Chaisson, Christine E Hane, Christopher Rumanes, Louis Tucker, Jamie Hang, Lillian McCoy, Rozalina Chen, Catherine L Bicket, Mark C Hooten, W Michael Larochelle, Marc Becker, William C Kornegay, Cynthia Racoosin, Judith A Sanghavi, Darshak |
| description | Opioid-tolerant only (OTO) medications, such as transmucosal immediate-release fentanyl products and certain extended-release opioid analgesics, require prior opioid tolerance for safe use, as patients without tolerance may be at increased risk of overdose. Studies using insurance claims have found that many patients initiating these medications do not appear to be opioid tolerant.
To measure prevalence of opioid tolerance in patients initiating OTO medications and to determine whether linked electronic health record (EHR) data contribute evidence of opioid tolerance not found in insurance claims data.
This retrospective cohort study used a national database of deidentified longitudinal health information, including medical and pharmacy claims, insurance enrollment, and EHR data, from January 1, 2007, to December 31, 2016. Data included 131 756 US residents with at least 183 days of continuous enrollment in commercial or Medicare Advantage insurance (including medical and pharmacy benefits) who had received an OTO medication and who had no inpatient stays in the 30 days prior to starting an OTO medication; of these, 20 044 individuals had linked EHR data within the prior 183 days. Data were analyzed from July 1, 2017, to August 31, 2018.
Initiating an OTO medication.
Prior opioid tolerance demonstrated through pharmacy fills or EHR data on prescriptions written.
Among 153 385 OTO use episodes identified, 89 029 (58.0%) occurred among women, 62 900 (41.0%) occurred among patients with Medicare Advantage insurance, 39 394 (25.7%) occurred in the Midwest, 17 366 (11.3%) occurred in the Northeast, 73 316 (47.8%) occurred in the South, and 23 309 (15.2%) occurred in the West. Less than half of use episodes (73 117 episodes [47.7%]) involved patients with evidence in claims data of opioid tolerance prior to initiating therapy with an OTO medication, including 31 392 of 101 676 episodes (30.9%) involving transdermal fentanyl, 1561 of 2440 episodes (64.0%) involving transmucosal fentanyl, 36 596 of 43 559 episodes (84.0%) involving extended-release oxycodone, and 3568 of 5710 episodes (62.5%) involving extended-release hydromorphone. Among 20 044 OTO use episodes with linked EHR and claims data, less than 1% of OTO episodes identified in claims had evidence of opioid tolerance in structured EHR data that was not present in claims data (108 episodes [0.5%]). After limiting the sample to OTO episodes identified in claims with a matching OTO prescription within 14 da |
| doi_str_mv | 10.1001/jamanetworkopen.2020.2875 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7160686</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2668404289</sourcerecordid><originalsourceid>FETCH-LOGICAL-a470t-d9507065f4c1ca5c13beffeb15e622695317ddf291de55240e8c50847fdde0b43</originalsourceid><addsrcrecordid>eNpdkV9LwzAUxYMoKupXkIrPmzdpk7Yvwhj-g8GG6HNI09uZ2TZd0in79qZsivp0L9zfPTcnh5ArCmMKQG9WqlEt9p_WvdsO2zEDBmOWpfyAnDKeJqM4A374qz8hF96vAAJH41zwY3ISM5bHIktOiZl4j9432PaRraKF7UNnVF1vo6dWdZ2znTOqx2jh0GtnCtMuB3DeGWvKaNKqeoneaB8943pj3DBeOGPdN_Fia3Sq1XhOjipVe7zY1zPyen_3Mn0czeYPT9PJbKSSFPpRmXNIQfAq0VQrrmlcYFVhQTkKxkTOY5qWZcVyWiLnLAHMNIcsSauyRCiS-Izc7nS7TdFgqYMfp2oZbDTKbaVVRv6dtOZNLu2HTKkAkYkgcL0XcHa9Qd_Lld24YNRLJsKnQcKyPFD5jtLOeu-w-rlAQQ5ByX9BySEoOQQVdi9_P_Fn8zuW-AtxMpdn</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2668404289</pqid></control><display><type>article</type><title>Assessment of Potentially Inappropriate Prescribing of Opioid Analgesics Requiring Prior Opioid Tolerance</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Jeffery, Molly Moore ; Chaisson, Christine E ; Hane, Christopher ; Rumanes, Louis ; Tucker, Jamie ; Hang, Lillian ; McCoy, Rozalina ; Chen, Catherine L ; Bicket, Mark C ; Hooten, W Michael ; Larochelle, Marc ; Becker, William C ; Kornegay, Cynthia ; Racoosin, Judith A ; Sanghavi, Darshak</creator><creatorcontrib>Jeffery, Molly Moore ; Chaisson, Christine E ; Hane, Christopher ; Rumanes, Louis ; Tucker, Jamie ; Hang, Lillian ; McCoy, Rozalina ; Chen, Catherine L ; Bicket, Mark C ; Hooten, W Michael ; Larochelle, Marc ; Becker, William C ; Kornegay, Cynthia ; Racoosin, Judith A ; Sanghavi, Darshak</creatorcontrib><description>Opioid-tolerant only (OTO) medications, such as transmucosal immediate-release fentanyl products and certain extended-release opioid analgesics, require prior opioid tolerance for safe use, as patients without tolerance may be at increased risk of overdose. Studies using insurance claims have found that many patients initiating these medications do not appear to be opioid tolerant.
To measure prevalence of opioid tolerance in patients initiating OTO medications and to determine whether linked electronic health record (EHR) data contribute evidence of opioid tolerance not found in insurance claims data.
This retrospective cohort study used a national database of deidentified longitudinal health information, including medical and pharmacy claims, insurance enrollment, and EHR data, from January 1, 2007, to December 31, 2016. Data included 131 756 US residents with at least 183 days of continuous enrollment in commercial or Medicare Advantage insurance (including medical and pharmacy benefits) who had received an OTO medication and who had no inpatient stays in the 30 days prior to starting an OTO medication; of these, 20 044 individuals had linked EHR data within the prior 183 days. Data were analyzed from July 1, 2017, to August 31, 2018.
Initiating an OTO medication.
Prior opioid tolerance demonstrated through pharmacy fills or EHR data on prescriptions written.
Among 153 385 OTO use episodes identified, 89 029 (58.0%) occurred among women, 62 900 (41.0%) occurred among patients with Medicare Advantage insurance, 39 394 (25.7%) occurred in the Midwest, 17 366 (11.3%) occurred in the Northeast, 73 316 (47.8%) occurred in the South, and 23 309 (15.2%) occurred in the West. Less than half of use episodes (73 117 episodes [47.7%]) involved patients with evidence in claims data of opioid tolerance prior to initiating therapy with an OTO medication, including 31 392 of 101 676 episodes (30.9%) involving transdermal fentanyl, 1561 of 2440 episodes (64.0%) involving transmucosal fentanyl, 36 596 of 43 559 episodes (84.0%) involving extended-release oxycodone, and 3568 of 5710 episodes (62.5%) involving extended-release hydromorphone. Among 20 044 OTO use episodes with linked EHR and claims data, less than 1% of OTO episodes identified in claims had evidence of opioid tolerance in structured EHR data that was not present in claims data (108 episodes [0.5%]). After limiting the sample to OTO episodes identified in claims with a matching OTO prescription within 14 days in the structured EHR data, only 40 of 939 episodes (4.0%) occurred among patients with evidence of tolerance that was not present in claims data.
This cohort study found that most patients initiating OTO medications did not have evidence of prior opioid tolerance, suggesting they were at increased risk of opioid-related harms, including fatal overdose. Data from EHRs did not contribute substantial additional evidence of opioid tolerance beyond the data found in prescription claims. Future research is needed to understand the clinical rationale behind these observed prescribing patterns and to quantify the risk of harm to patients associated with potentially inappropriate prescribing.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2020.2875</identifier><identifier>PMID: 32293684</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Analgesics ; Analgesics, Opioid - adverse effects ; Analgesics, Opioid - therapeutic use ; Child ; Child, Preschool ; Chronic Pain - drug therapy ; Cohort Studies ; Delayed-Action Preparations - adverse effects ; Drug Overdose - epidemiology ; Drug Tolerance ; Electronic health records ; Female ; Fentanyl ; Humans ; Inappropriate Prescribing - statistics & numerical data ; Infant ; Infant, Newborn ; Insurance claims ; Longitudinal Studies ; Male ; Medicare ; Middle Aged ; Narcotics ; Online Only ; Original Investigation ; Pharmacy ; Pharmacy and Clinical Pharmacology ; Practice Patterns, Physicians' - statistics & numerical data ; Prevalence ; Retrospective Studies ; United States - epidemiology ; Young Adult</subject><ispartof>JAMA network open, 2020-04, Vol.3 (4), p.e202875</ispartof><rights>2020. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2020 Jeffery MM et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a470t-d9507065f4c1ca5c13beffeb15e622695317ddf291de55240e8c50847fdde0b43</citedby><cites>FETCH-LOGICAL-a470t-d9507065f4c1ca5c13beffeb15e622695317ddf291de55240e8c50847fdde0b43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,864,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32293684$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jeffery, Molly Moore</creatorcontrib><creatorcontrib>Chaisson, Christine E</creatorcontrib><creatorcontrib>Hane, Christopher</creatorcontrib><creatorcontrib>Rumanes, Louis</creatorcontrib><creatorcontrib>Tucker, Jamie</creatorcontrib><creatorcontrib>Hang, Lillian</creatorcontrib><creatorcontrib>McCoy, Rozalina</creatorcontrib><creatorcontrib>Chen, Catherine L</creatorcontrib><creatorcontrib>Bicket, Mark C</creatorcontrib><creatorcontrib>Hooten, W Michael</creatorcontrib><creatorcontrib>Larochelle, Marc</creatorcontrib><creatorcontrib>Becker, William C</creatorcontrib><creatorcontrib>Kornegay, Cynthia</creatorcontrib><creatorcontrib>Racoosin, Judith A</creatorcontrib><creatorcontrib>Sanghavi, Darshak</creatorcontrib><title>Assessment of Potentially Inappropriate Prescribing of Opioid Analgesics Requiring Prior Opioid Tolerance</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>Opioid-tolerant only (OTO) medications, such as transmucosal immediate-release fentanyl products and certain extended-release opioid analgesics, require prior opioid tolerance for safe use, as patients without tolerance may be at increased risk of overdose. Studies using insurance claims have found that many patients initiating these medications do not appear to be opioid tolerant.
To measure prevalence of opioid tolerance in patients initiating OTO medications and to determine whether linked electronic health record (EHR) data contribute evidence of opioid tolerance not found in insurance claims data.
This retrospective cohort study used a national database of deidentified longitudinal health information, including medical and pharmacy claims, insurance enrollment, and EHR data, from January 1, 2007, to December 31, 2016. Data included 131 756 US residents with at least 183 days of continuous enrollment in commercial or Medicare Advantage insurance (including medical and pharmacy benefits) who had received an OTO medication and who had no inpatient stays in the 30 days prior to starting an OTO medication; of these, 20 044 individuals had linked EHR data within the prior 183 days. Data were analyzed from July 1, 2017, to August 31, 2018.
Initiating an OTO medication.
Prior opioid tolerance demonstrated through pharmacy fills or EHR data on prescriptions written.
Among 153 385 OTO use episodes identified, 89 029 (58.0%) occurred among women, 62 900 (41.0%) occurred among patients with Medicare Advantage insurance, 39 394 (25.7%) occurred in the Midwest, 17 366 (11.3%) occurred in the Northeast, 73 316 (47.8%) occurred in the South, and 23 309 (15.2%) occurred in the West. Less than half of use episodes (73 117 episodes [47.7%]) involved patients with evidence in claims data of opioid tolerance prior to initiating therapy with an OTO medication, including 31 392 of 101 676 episodes (30.9%) involving transdermal fentanyl, 1561 of 2440 episodes (64.0%) involving transmucosal fentanyl, 36 596 of 43 559 episodes (84.0%) involving extended-release oxycodone, and 3568 of 5710 episodes (62.5%) involving extended-release hydromorphone. Among 20 044 OTO use episodes with linked EHR and claims data, less than 1% of OTO episodes identified in claims had evidence of opioid tolerance in structured EHR data that was not present in claims data (108 episodes [0.5%]). After limiting the sample to OTO episodes identified in claims with a matching OTO prescription within 14 days in the structured EHR data, only 40 of 939 episodes (4.0%) occurred among patients with evidence of tolerance that was not present in claims data.
This cohort study found that most patients initiating OTO medications did not have evidence of prior opioid tolerance, suggesting they were at increased risk of opioid-related harms, including fatal overdose. Data from EHRs did not contribute substantial additional evidence of opioid tolerance beyond the data found in prescription claims. Future research is needed to understand the clinical rationale behind these observed prescribing patterns and to quantify the risk of harm to patients associated with potentially inappropriate prescribing.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analgesics</subject><subject>Analgesics, Opioid - adverse effects</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Chronic Pain - drug therapy</subject><subject>Cohort Studies</subject><subject>Delayed-Action Preparations - adverse effects</subject><subject>Drug Overdose - epidemiology</subject><subject>Drug Tolerance</subject><subject>Electronic health records</subject><subject>Female</subject><subject>Fentanyl</subject><subject>Humans</subject><subject>Inappropriate Prescribing - statistics & numerical data</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Insurance claims</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medicare</subject><subject>Middle Aged</subject><subject>Narcotics</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Pharmacy</subject><subject>Pharmacy and Clinical Pharmacology</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Prevalence</subject><subject>Retrospective Studies</subject><subject>United States - epidemiology</subject><subject>Young Adult</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkV9LwzAUxYMoKupXkIrPmzdpk7Yvwhj-g8GG6HNI09uZ2TZd0in79qZsivp0L9zfPTcnh5ArCmMKQG9WqlEt9p_WvdsO2zEDBmOWpfyAnDKeJqM4A374qz8hF96vAAJH41zwY3ISM5bHIktOiZl4j9432PaRraKF7UNnVF1vo6dWdZ2znTOqx2jh0GtnCtMuB3DeGWvKaNKqeoneaB8943pj3DBeOGPdN_Fia3Sq1XhOjipVe7zY1zPyen_3Mn0czeYPT9PJbKSSFPpRmXNIQfAq0VQrrmlcYFVhQTkKxkTOY5qWZcVyWiLnLAHMNIcsSauyRCiS-Izc7nS7TdFgqYMfp2oZbDTKbaVVRv6dtOZNLu2HTKkAkYkgcL0XcHa9Qd_Lld24YNRLJsKnQcKyPFD5jtLOeu-w-rlAQQ5ByX9BySEoOQQVdi9_P_Fn8zuW-AtxMpdn</recordid><startdate>20200401</startdate><enddate>20200401</enddate><creator>Jeffery, Molly Moore</creator><creator>Chaisson, Christine E</creator><creator>Hane, Christopher</creator><creator>Rumanes, Louis</creator><creator>Tucker, Jamie</creator><creator>Hang, Lillian</creator><creator>McCoy, Rozalina</creator><creator>Chen, Catherine L</creator><creator>Bicket, Mark C</creator><creator>Hooten, W Michael</creator><creator>Larochelle, Marc</creator><creator>Becker, William C</creator><creator>Kornegay, Cynthia</creator><creator>Racoosin, Judith A</creator><creator>Sanghavi, Darshak</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope></search><sort><creationdate>20200401</creationdate><title>Assessment of Potentially Inappropriate Prescribing of Opioid Analgesics Requiring Prior Opioid Tolerance</title><author>Jeffery, Molly Moore ; Chaisson, Christine E ; Hane, Christopher ; Rumanes, Louis ; Tucker, Jamie ; Hang, Lillian ; McCoy, Rozalina ; Chen, Catherine L ; Bicket, Mark C ; Hooten, W Michael ; Larochelle, Marc ; Becker, William C ; Kornegay, Cynthia ; Racoosin, Judith A ; Sanghavi, Darshak</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a470t-d9507065f4c1ca5c13beffeb15e622695317ddf291de55240e8c50847fdde0b43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analgesics</topic><topic>Analgesics, Opioid - adverse effects</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Chronic Pain - drug therapy</topic><topic>Cohort Studies</topic><topic>Delayed-Action Preparations - adverse effects</topic><topic>Drug Overdose - epidemiology</topic><topic>Drug Tolerance</topic><topic>Electronic health records</topic><topic>Female</topic><topic>Fentanyl</topic><topic>Humans</topic><topic>Inappropriate Prescribing - statistics & numerical data</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Insurance claims</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medicare</topic><topic>Middle Aged</topic><topic>Narcotics</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Pharmacy</topic><topic>Pharmacy and Clinical Pharmacology</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Prevalence</topic><topic>Retrospective Studies</topic><topic>United States - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jeffery, Molly Moore</creatorcontrib><creatorcontrib>Chaisson, Christine E</creatorcontrib><creatorcontrib>Hane, Christopher</creatorcontrib><creatorcontrib>Rumanes, Louis</creatorcontrib><creatorcontrib>Tucker, Jamie</creatorcontrib><creatorcontrib>Hang, Lillian</creatorcontrib><creatorcontrib>McCoy, Rozalina</creatorcontrib><creatorcontrib>Chen, Catherine L</creatorcontrib><creatorcontrib>Bicket, Mark C</creatorcontrib><creatorcontrib>Hooten, W Michael</creatorcontrib><creatorcontrib>Larochelle, Marc</creatorcontrib><creatorcontrib>Becker, William C</creatorcontrib><creatorcontrib>Kornegay, Cynthia</creatorcontrib><creatorcontrib>Racoosin, Judith A</creatorcontrib><creatorcontrib>Sanghavi, Darshak</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jeffery, Molly Moore</au><au>Chaisson, Christine E</au><au>Hane, Christopher</au><au>Rumanes, Louis</au><au>Tucker, Jamie</au><au>Hang, Lillian</au><au>McCoy, Rozalina</au><au>Chen, Catherine L</au><au>Bicket, Mark C</au><au>Hooten, W Michael</au><au>Larochelle, Marc</au><au>Becker, William C</au><au>Kornegay, Cynthia</au><au>Racoosin, Judith A</au><au>Sanghavi, Darshak</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of Potentially Inappropriate Prescribing of Opioid Analgesics Requiring Prior Opioid Tolerance</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>3</volume><issue>4</issue><spage>e202875</spage><pages>e202875-</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>Opioid-tolerant only (OTO) medications, such as transmucosal immediate-release fentanyl products and certain extended-release opioid analgesics, require prior opioid tolerance for safe use, as patients without tolerance may be at increased risk of overdose. Studies using insurance claims have found that many patients initiating these medications do not appear to be opioid tolerant.
To measure prevalence of opioid tolerance in patients initiating OTO medications and to determine whether linked electronic health record (EHR) data contribute evidence of opioid tolerance not found in insurance claims data.
This retrospective cohort study used a national database of deidentified longitudinal health information, including medical and pharmacy claims, insurance enrollment, and EHR data, from January 1, 2007, to December 31, 2016. Data included 131 756 US residents with at least 183 days of continuous enrollment in commercial or Medicare Advantage insurance (including medical and pharmacy benefits) who had received an OTO medication and who had no inpatient stays in the 30 days prior to starting an OTO medication; of these, 20 044 individuals had linked EHR data within the prior 183 days. Data were analyzed from July 1, 2017, to August 31, 2018.
Initiating an OTO medication.
Prior opioid tolerance demonstrated through pharmacy fills or EHR data on prescriptions written.
Among 153 385 OTO use episodes identified, 89 029 (58.0%) occurred among women, 62 900 (41.0%) occurred among patients with Medicare Advantage insurance, 39 394 (25.7%) occurred in the Midwest, 17 366 (11.3%) occurred in the Northeast, 73 316 (47.8%) occurred in the South, and 23 309 (15.2%) occurred in the West. Less than half of use episodes (73 117 episodes [47.7%]) involved patients with evidence in claims data of opioid tolerance prior to initiating therapy with an OTO medication, including 31 392 of 101 676 episodes (30.9%) involving transdermal fentanyl, 1561 of 2440 episodes (64.0%) involving transmucosal fentanyl, 36 596 of 43 559 episodes (84.0%) involving extended-release oxycodone, and 3568 of 5710 episodes (62.5%) involving extended-release hydromorphone. Among 20 044 OTO use episodes with linked EHR and claims data, less than 1% of OTO episodes identified in claims had evidence of opioid tolerance in structured EHR data that was not present in claims data (108 episodes [0.5%]). After limiting the sample to OTO episodes identified in claims with a matching OTO prescription within 14 days in the structured EHR data, only 40 of 939 episodes (4.0%) occurred among patients with evidence of tolerance that was not present in claims data.
This cohort study found that most patients initiating OTO medications did not have evidence of prior opioid tolerance, suggesting they were at increased risk of opioid-related harms, including fatal overdose. Data from EHRs did not contribute substantial additional evidence of opioid tolerance beyond the data found in prescription claims. Future research is needed to understand the clinical rationale behind these observed prescribing patterns and to quantify the risk of harm to patients associated with potentially inappropriate prescribing.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>32293684</pmid><doi>10.1001/jamanetworkopen.2020.2875</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | JAMA network open, 2020-04, Vol.3 (4), p.e202875 |
| issn | 2574-3805 2574-3805 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Age Factors Aged Aged, 80 and over Analgesics Analgesics, Opioid - adverse effects Analgesics, Opioid - therapeutic use Child Child, Preschool Chronic Pain - drug therapy Cohort Studies Delayed-Action Preparations - adverse effects Drug Overdose - epidemiology Drug Tolerance Electronic health records Female Fentanyl Humans Inappropriate Prescribing - statistics & numerical data Infant Infant, Newborn Insurance claims Longitudinal Studies Male Medicare Middle Aged Narcotics Online Only Original Investigation Pharmacy Pharmacy and Clinical Pharmacology Practice Patterns, Physicians' - statistics & numerical data Prevalence Retrospective Studies United States - epidemiology Young Adult |
| title | Assessment of Potentially Inappropriate Prescribing of Opioid Analgesics Requiring Prior Opioid Tolerance |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T15%3A00%3A16IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Assessment%20of%20Potentially%20Inappropriate%20Prescribing%20of%20Opioid%20Analgesics%20Requiring%20Prior%20Opioid%20Tolerance&rft.jtitle=JAMA%20network%20open&rft.au=Jeffery,%20Molly%20Moore&rft.date=2020-04-01&rft.volume=3&rft.issue=4&rft.spage=e202875&rft.pages=e202875-&rft.issn=2574-3805&rft.eissn=2574-3805&rft_id=info:doi/10.1001/jamanetworkopen.2020.2875&rft_dat=%3Cproquest_pubme%3E2668404289%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2668404289&rft_id=info:pmid/32293684&rfr_iscdi=true |