Age and Gender Trends in Long-Term Opioid Analgesic Use for Noncancer Pain

Campbell, Cynthia I.; Weisner, Constance; LeResche, Linda; Ray, G. Thomas; Saunders, Kathleen; Sullivan, Mark D.; Banta‐Green, Caleb J.; Merrill, Joseph O.; Silverberg, Michael J.; Boudreau, Denise M.; Satre, Derek D.; Korff, Michael Von

doi:10.2105/ajph.2009.180646

Cited by 292 publications

(283 citation statements)

References 32 publications

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“…While not all prevalent prescribing in our study constitutes long-term use, as defined elsewhere, 24 Edlund et al 22 found that the majority of veterans with chronic noncancer pain receiving opioids had over 90 days prescribed per year. Rates of long-term opioid use in two large health plans increased substantially from 1997 to 2005, 25 suggesting that trends outside VHA parallel our observations. The reasons for both the increase and the regional variation in prevalent opioid receipt are unclear.…”

Section: Discussionsupporting

confidence: 78%

Trends in Prevalent and Incident Opioid Receipt: an Observational Study in Veterans Health Administration 2004–2012

et al. 2014

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BACKGROUND: Improved understanding of temporal and regional trends may support safe and effective prescribing of opioids. OBJECTIVE: We describe national, regional, and facilitylevel trends and variations in opioid receipt between fiscal years (FY) 2004 and 2012. DESIGN: Observational cohort study using Veterans Health Administration (VHA) administrative databases. PARTICIPANTS: All patients receiving primary care within 137 VHA healthcare systems during a given study year and receiving medications from VHA one year before and during a given study year. MAIN MEASURES: Prevalent and incident opioid receipt during each year of the study period. KEY RESULTS: The overall prevalence of opioid receipt increased from 18.9 % of all veteran outpatients in FY2004 to 33.4 % in FY2012, a 76.7 % relative increase. In FY2012, women had higher rates of prevalent opioid receipt than men (42.4 % vs. 32.9 %), and the youngest veterans (18-34 years) had higher prevalent opioid receipt compared to the oldest veterans (≥80 years) (47.6 % vs. 17.9 %). All regions in the United States saw increased rates of prevalent opioid receipt during this time period. Prevalence rates varied widely by facility: in FY2012, the lowest-prescribing facility had a rate of 13.5 %, and the highest of 50.8 %. Annual incident opioid receipt increased from 8.8 % in FY2004 to 10.2 % in FY2011, with a decline to 9.8 % in FY2012. Incident prescribing increased at some facilities and decreased at others. Facilities with high prevalent prescribing tended to have flat or decreasing incident prescribing rates during the study time frame. CONCLUSIONS: Rates of opioid receipt increased throughout the study time frame, with wide variation in prevalent and incident rates across geographical region, sex, and age groups. Prevalence and incidence rates reflect distinct prescribing practices. Areas with the highest prevalence tended to have lower increases in incident opioid receipt over the study period. This likely reflects facilitylevel variations in prescribing practices as well as baseline rates of prevalent use. Future work assessing opioid prescribing should employ methodologies to account for and interpret both prevalent and incident opioid receipt.

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Section: Discussionsupporting

confidence: 78%

Trends in Prevalent and Incident Opioid Receipt: an Observational Study in Veterans Health Administration 2004–2012

et al. 2014

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“…This definition is similar to that used in the CONSORT study of long-term opioid users. 18,19 Using this definition of long-term use of opioids, some episodes could have been for continuous use whereas others could have been for sporadic or intermittent use. We therefore categorized episodes of long-term opioid use into four groups based on the frequency of drug use.…”

Section: Definitions Of Key Variablesmentioning

confidence: 99%

Patterns and trends in long-term opioid use for non-cancer pain in British Columbia, 2005–2012

Smolina

Gladstone

Rutherford

et al. 2016

Can J Public Health

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OBJECTIVES:We aimed to calculate trends in incidence and prevalence rates of long-term opioid use for non-cancer pain, as well as to describe the characteristics of long-term opioid users and their patterns of opioid use. METHODS:We used population-based linked health care and socio-demographic administrative data for British Columbia (BC) between 2005 and 2012. We included individuals who had at least one episode of long-term opioid use during the study period and who were not cancer or palliative care patients.RESULTS: Long-term users comprised only 10% of all individuals prescribed opioids for non-cancer pain, but accounted for 64% of all opioid prescriptions and 87% of all morphine equivalents dispensed in BC during this period. While the incidence rate did not significantly change, the prevalence rate increased by 27% for men and 22% for women. In 2012, there were 3.80 (3.72-3.88) new long-term opioid users per 1,000 men and 4.42 (4.34-4.51) new users per 1,000 women. At the same time, there were 18.3 (95% CI 18.1-18.5) existing long-term users per 1,000 men and 21.7 users (95% CI 21.5-21.9) per 1,000 women. Overall, 2.4% of BC residents were long-term users of prescription opioids in 2012. Most long-term users had one continuous episode of use spanning multiple years. Almost two thirds took opioids every other day or more frequently. CONCLUSION:There is a growing population of long-term opioid users for non-cancer pain in BC, with higher incidence and prevalence rates observed among women than among men.KEY WORDS: Opioid analgesics; chronic pain; incidence; prevalence; inappropriate prescribing La traduction du résumé se trouve à la fin de l'article.

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“…Opioid use may be related to RA or comorbidities; increasing use reflects national trends. 19 We cannot comment on whether this increase was appropriate because we did not analyze patient-level data on the indication for opioid use. Optimal use of opioids remains an area for intervention.…”

Section: Discussionmentioning

confidence: 99%

Population Variations in Rheumatoid Arthritis Treatment and Outcomes, Northern California, 1998–2009

Herrinton¹,

Harrold

Salman

et al. 2016

TPJ

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Objective: To assess variations in rheumatoid arthritis treatment and outcomes at the community level from 1998 through 2009. Methods:The study used computerized data from 16 Kaiser Permanente Northern California Medical Centers. Mixed modeling was used to assess patterns across time and clinic. The analysis accounted for patient demographics, clustering of patients within Medical Centers, and repeated measures of patients over time. The metric used to measure drug use, months of use per patient per year, included both users and nonusers in the denominator, to account for both prevalence and duration of use.Results: Assessment was performed of 28,601 patients with rheumatoid arthritis, with all levels of severity. From 1998 through 2009, methotrexate use doubled in the typical patient to include 23% of the time they were observed; sulfasalazine and hydrochloroquine use declined. By 2008 through 2009, leflunomide and antitumor necrosis factor agents were used by the typical patient 4% and 9% of the time, respectively. Between 1998 and 2009, disease-modifying antirheumatic drug use increased in the typical patient from 38% to 63% of the time, and oral prednisone use declined from 23% to 15% of the time, whereas opioid use initially rose but then fell to 23% of the time. No variations over time were observed for the rate of hospitalized pneumonia or opportunistic infection. Variation across clinics, measured by the difference in drug use between clinics at the 75th and 25th percentiles, was lowest for opioids (25% vs 20% of the time) and greatest for infliximab (< 1% to 3%).Conclusion: Increased use of disease-modifying antirheumatic drugs and declines in prednisone are encouraging. Opioid use may need intervention.

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Age and Gender Trends in Long-Term Opioid Analgesic Use for Noncancer Pain

Cited by 292 publications

References 32 publications

Trends in Prevalent and Incident Opioid Receipt: an Observational Study in Veterans Health Administration 2004–2012

Trends in Prevalent and Incident Opioid Receipt: an Observational Study in Veterans Health Administration 2004–2012

Patterns and trends in long-term opioid use for non-cancer pain in British Columbia, 2005–2012

Population Variations in Rheumatoid Arthritis Treatment and Outcomes, Northern California, 1998–2009

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