Patterns of Prescription Opioid Use in Women With Endometriosis: Evaluating Prolonged Use, Daily Dose, and Concomitant Use With Benzodiazepines

Abstract

To examine opioid use, opioid prescribing patterns, and timing of the first opioid prescription in endometriosis patients compared with matched women in the control group without endometriosis. METHODS:We conducted a retrospective analysis of the Clinformatics Datamart database. Women diagnosed with endometriosis from January 2006 through December 2016 and aged 18-49 years were compared with women in the control group matched on age, region, race, insurance payer, and plan type. Key outcomes included: filled prescription for an opioid, multiple opioid prescriptions, number of days' supply, daily dose (morphine milligram equivalents), and concomitant opioid and benzodiazepine prescriptions. Cohorts were descriptively analyzed using t-and x 2 statistics and multivariable regression analyses yielded adjusted relative risk (RR) ratios and 95% CI. RESULTS:The study sample included 53,847 endometriosis patients and 107,694 patients in the control group. The mean age was 38 years, 62.4% of patients were white, and 51.6% lived in the South. Women in the endometriosis case group, compared with women in the control group, were more likely to fill an opioid prescription (42,705 [79.3%] women in the case group vs 26,106 [24.2%] women in the control group; adjusted RR ratio 2.91; 2.87-2.94), had higher likelihood of filling prescriptions with a dose of 50 morphine milligram equivalents or more (24,544 [45.6%] vs 10,463 [9.7%]; adjusted RR ratio 4.07; 3.98-4.16) or 100 morphine milligram equivalents or more (8,013 [14.9%] vs 3,582 [3.3%]; adjusted RR ratio 3.56; 3.43-3.70). Women in the case group were more likely to have concomitant opioid and benzodiazepine prescriptions (5,453 [10.1%] vs 3,711 [3.5%]; adjusted RR ratio 1.95; 1.88-2.03) and to have used these drugs concurrently for at least 30 days (1,596 [3.0%] vs 1,265 [1.2%]; adjusted RR ratio 1.43; 1.34-1.52) or at least 90 days (875 [1.6%] vs 777 [0.7%]; adjusted RR ratio 1.27; 1.17-1.37). Similar results were obtained after excluding opioid prescriptions received during a 30-day postsurgery window.CONCLUSION: Women with endometriosis had higher probabilities of prolonged use of opioids and concomitant use with benzodiazepines compared with women without this condition.

The impact of high-risk and chronic opioid use among commercially insured endometriosis patients on health care resource utilization and costs in the United States

“…15,16 Compared with matched women without endometriosis, women with endometriosis have a greater risk to fill a prescription for an opioid (adjusted risk ratio (RR): 2.91) and for filling prescriptions for prolonged use, a higher dose, and/or a benzodiazepine. 15 Women with endometriosis also have a greater risk at chronic opioid use (adjusted RR: 2.11). 15,16 A 2019 retrospective analysis of opioid-using women with endometriosis found that the average (standard deviation, SD) number of opioid prescriptions received was 4.6 (6.7), average days supply was 61.1 (128.6) days, and 18.1% received ⩾90 days of opioids.…”

“…14 Women with endometriosis have a greater risk at receiving opioids. 15,16 Compared with matched women without endometriosis, women with endometriosis have a greater risk to fill a prescription for an opioid (adjusted risk ratio (RR): 2.91) and for filling prescriptions for prolonged use, a higher dose, and/or a benzodiazepine. 15 Women with endometriosis also have a greater risk at chronic opioid use (adjusted RR: 2.11).…”

“…15 Women with endometriosis also have a greater risk at chronic opioid use (adjusted RR: 2.11). 15,16 A 2019 retrospective analysis of opioid-using women with endometriosis found that the average (standard deviation, SD) number of opioid prescriptions received was 4.6 (6.7), average days supply was 61.1 (128.6) days, and 18.1% received ⩾90 days of opioids. 17 A 2016 survey of fellows conducted by the American College of Obstetricians and Gynecologists (ACOG) fellows found that 24% of patients with endometriosis received opioid medication prescribed by US OB/ GYNs.…”

Chronic opioid use and complication risks in women with endometriosis: A cohort study in US administrative claims

“…Recent studies in administrative claims databases have demonstrated that more than half of women fill a prescription for opioids, primarily short-acting opioids, after receiving a diagnosis code for endometriosis. 7 Further, women with endometriosis are more likely to fill at least one prescription for opioids than women without endometriosis, to be prescribed opioids at higher doses, for a greater number of days and concomitantly with benzodiazepines for up to 90 days than women without endometriosis, 6 leading to greater healthcare utilization and costs. 8,9 The current study expands these findings by demonstrating that there is an elevated risk of chronic opioid use.…”

“…Recent studies have demonstrated that women with endometriosis were more likely to fill a prescription for opioids, take higher doses, for a longer time, and concomitantly with benzodiazepines than women without endometriosis. 6,7 Further, women prescribed opioids had significantly higher healthcare burden, resource utilization and costs compared to non-opioid users over 2 years. 8,9 However the risk of chronic opioid use has not been quantified.…”