Complex Persistent Opioid Dependence with Long-term Opioids: a Gray Area That Needs Definition, Better Understanding, Treatment Guidance, and Policy Changes

Manhapra, Ajay; Sullivan, Mark D.; Ballantyne, Jane C.; MacLean, R. Ross; Becker, William C.

doi:10.1007/s11606-020-06251-w

Cited by 37 publications

(38 citation statements)

References 34 publications

(64 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Notably, these patients were long-term opioid users with indications of potential problematic opioid use but lack the DSM-V signs of compulsive use characteristic of OUD. These individuals may represent a group of chronic pain patients with Complex Persistent Opioid Dependence (CPOD) [7][8][9]. CPOD, the gray area between opioid dependence and addiction, develops slowly, almost imperceptibly, with longterm opioid exposure [7].…”

Section: Discussionmentioning

confidence: 99%

“…These individuals may represent a group of chronic pain patients with Complex Persistent Opioid Dependence (CPOD) [7][8][9]. CPOD, the gray area between opioid dependence and addiction, develops slowly, almost imperceptibly, with longterm opioid exposure [7]. By assessing problematic opioid use risk using a continuous score, these data-driven approaches may identify signs of impending problematic opioid use indiscernible to human clinicians.…”

Section: Discussionmentioning

confidence: 99%

“…Retrospective observational studies are valuable research tools for examining epidemiology, disease progression, and treatment effectiveness [4], however, their use is hampered in opioid use disorder (OUD) research due to difficulties in OUD detection in Electronic Health Records (EHR) data. Providers are often reluctant to document concerns about opioid use in health records due to the stigmatizing nature of diagnoses, potential difficulties in future pain management, fear of misclassification, and poorly defined diagnostic criteria [5][6][7][8][9][10]. Therefore, standard approaches for identifying cases in EHR data, such as International Classification of Diseases (ICD) codes or problem lists, insufficiently capture OUD [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Two Data-Driven Approaches to Identifying the Spectrum of Problematic Opioid Use: A Pilot Study within a Chronic Pain Cohort

Schirle¹,

Jeffery²,

Yaqoob

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Although electronic health records (EHR) have significant potential for the study of opioid use disorders (OUD), detecting OUD in clinical data is challenging. Models using EHR data to predict OUD often rely on case/control classifications focused on extreme opioid use. There is a need to expand this work to characterize the spectrum of problematic opioid use. Methods: Using a large academic medical center database, we developed 2 data-driven methods of OUD detection: (1) a Comorbidity Score developed from a Phenome-Wide Association Study of phenotypes associated with OUD and (2) a Text-based Score using natural language processing to identify OUD-related concepts in clinical notes. We evaluated the performance of both scores against a manual review with correlation coefficients, Wilcoxon rank sum tests, and area-under the receiver operating characteristic curves. Records with the highest Comorbidity and Text-based scores were re-evaluated by manual review to explore discrepancies. Results: Both the Comorbidity and Text-based OUD risk scores were significantly elevated in the patients judged as High Evidence for OUD in the manual review compared to those with No Evidence (p = 1.3E-5 and 1.3E-6, respectively). The risk scores were positively correlated with each other (rho = 0.52, p < 0.001). AUCs for the Comorbidity and Text-based scores were high (0.79 and 0.76, respectively). Follow-up manual review of discrepant findings revealed strengths of data-driven methods over manual review, and opportunities for improvement in risk assessment. Conclusion: Risk scores comprising comorbidities and text offer differing but synergistic insights into characterizing problematic opioid use. This pilot project establishes a foundation for more robust work in the future.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Two Data-Driven Approaches to Identifying the Spectrum of Problematic Opioid Use: A Pilot Study within a Chronic Pain Cohort

Schirle¹,

Jeffery²,

Yaqoob

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Treatment seeking for prescription OUD was the lowest (16% for 12-month treatment and 29% for lifetime treatment) and for heroin plus combined OUD was the highest (54% for lifetime treatment). Reduced treatment seeking in those with prescription OUD when compared with heroin OUD could be explained by the difficulty in diagnosing prescription OUD due to co-existing complex pain management needs and long term opioid use [38]. Secondly, lower levels of treatment seeking in those with prescription OUD may be related to treatment appropriateness.…”

Section: Discussionmentioning

confidence: 99%

Treatment-seeking behaviour among people with opioid use disorder in the high-income countries: A systematic review and meta-analysis

Hall

Majmudar

et al. 2021

PLoS ONE

View full text Add to dashboard Cite

Objectives To determine treatment seeking behaviour in those with opioid use disorder (OUD) in the high-income countries. Methods Five databases were searched in November 2019 for quantitative studies that reported OUD treatment seeking behaviour. Data analysis involved determining an overall pooled proportion estimate of treatment seeking behaviour for the two base groups, lifetime treatment and past 12-month or less treatment using the IVhet effect model. Subgroup analysis included heroin OUD, prescription OUD and general OUD. The sensitivity analysis included removal of outliers, separating adults and adolescents and the metaXL sensitivity analysis (studies are excluded if outside the pooled proportion confidence interval of the base case). Systematic review Prospero database registration number [CRD42020159531]. Results There were 13 quantitative studies included in the systematic review, with all studies being from the United States of America (USA). IVhet models showed that 40% (95% CI: 23%, 58%) and 21% (95% CI: 16%, 26%) sought treatment in their lifetime and past 12 months respectively. Sub-group analysis found that lifetime treatment seeking for prescription OUD, 29% (95% CI: 27%, 31%), was less than for heroin plus combined OUD, 54% (95% CI: 26%, 82%). Most of the pooled results had high heterogeneity statistics except for results of lifetime treatment seeking for prescription OUD and past 12-month treatment seeking for prescription OUD. Conclusion All included studies in this meta-analysis were from the USA and indicate modest levels of treatment seeking for those with OUD. In particular, this review found that in the USA one in five people with OUD sought OUD treatment in the previous 12 months and two in five people with OUD sought OUD treatment in their lifetime. Further research is urgently required to explore the barriers and facilitators that can improve this low treatment seeking in those with OUD.

show abstract

“…An important clinical and policy issue identified by the workgroup was the challenge of applying the Diagnostic and Statistical Manual-5's OUD criteria to patients on long-term opioid therapy for pain who have symptoms of physical dependence but do nor exhibit compulsive use. Highlighted in this special issue by Manhapra et al, 10 these concerns are the subject of an ongoing Delphi study of subject matter experts called for by the SOTA to explore whether a new diagnostic entity is needed for this population and, if so, what its criteria should be.…”

mentioning

confidence: 99%

Mounting a Scientifically Informed Response to the Opioid Crisis in the Veterans Health Administration

et al. 2020

Self Cite

View full text Add to dashboard Cite

Complex Persistent Opioid Dependence with Long-term Opioids: a Gray Area That Needs Definition, Better Understanding, Treatment Guidance, and Policy Changes

Abstract: have no conflict of interest or other disclosures to make. Jane C. Ballantyne was a paid consultant in opioid litigation. Publisher's Note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Cited by 37 publications

References 34 publications

Two Data-Driven Approaches to Identifying the Spectrum of Problematic Opioid Use: A Pilot Study within a Chronic Pain Cohort

Two Data-Driven Approaches to Identifying the Spectrum of Problematic Opioid Use: A Pilot Study within a Chronic Pain Cohort

Treatment-seeking behaviour among people with opioid use disorder in the high-income countries: A systematic review and meta-analysis

Mounting a Scientifically Informed Response to the Opioid Crisis in the Veterans Health Administration

Contact Info

Product

Resources

About