Trends in opioid use disorder and overdose among opioid‐naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014

Abstract

Aims To examine how the risks of incident opioid use disorder (OUD), non‐fatal and fatal overdose have changed over time among opioid‐naive individuals receiving an initial opioid prescription. Design Retrospective, longitudinal study using the Massachusetts Chapter 55 data set, which linked multiple administrative data sets to study the opioid epidemic. We identified the cumulative incidence of OUD, non‐fatal and fatal overdose among the opioid‐naive initiating opioid treatment in Massachusetts from 2011 to 2014 and estimated rates of these outcomes at 6 months and at 1, 2, 3 and 4 years to 2015. We used Cox regression to examine the association between characteristics of the initial prescription and risk of these outcomes. Setting Massachusetts, USA. Participants Massachusetts residents aged ≥ 11 years in 2011–15 who were opioid‐naive (no opioid prescriptions or evidence of OUD in the 6 months prior to the index prescription) (n = 2 154 426). The mean age was 49.1 years, 55.3% were female and 47.3% had commercial insurance. Measurements Opioid prescriptions were identified in the Prescription Monitoring Program (PMP) database, as were the characteristics of the initial prescription database. The outcomes of OUD and non‐fatal overdose were identified from claims in the All Payer Claims Database (APCD) and hospital encounters in the acute hospital case mix files. Fatal overdoses were identified using Registry of Vital Records and Statistics (RVRS) death certificates and the Office of the Chief Medical Examiner (OCME) circumstances of death and toxicology reports. Findings Among opioid‐naive individuals receiving an initial opioid prescription, the risk of incident OUD appears to have declined between 2011 and 2014, while rates of overdose were largely unchanged. For example, the 1‐year OUD rate was 1.18% in 2011, 1.11% in 2012, 1.26% in 2013 and 0.94% in 2014. Longer therapy duration was associated with higher risk of OUD [hazard ratio (HR) = 2.24, 95% confidence interval (CI) = 2.19–2.29 for duration of 3 or more months], non‐fatal (HR = 1.67, 95% CI = 1.53–1.82) and fatal opioid overdose (HR = 2.24, 95% CI = 1.91–2.61). Concurrent benzodiazepine treatment was also associated with higher risk of OUD (HR = 1.14, 95% CI = 1.12–1.17), non‐fatal (HR = 1.20, 95% CI = 1.10–1.30) and fatal overdose (HR = 1.86, 95% CI = 1.61–2.16). Conclusions Among opioid‐naive individuals in Massachusetts receiving an initial opioid prescription, the risk of incident opioid use disorder appears to have declined between 2011 and 2014, while rates of overdose were largely unchanged. Longer therapy duration and concurrent benzodiazepines were associated with higher rates of opioid use disorder and opioid overdose.

Operationalizing and selecting outcome measures for the HEALing Communities Study

“…All-payer claims have been used previously in OUD-related research ( Burke et al, 2020 ; Freedman et al, 2016 ; LeBaron et al, 2019 ; Saloner et al, 2017 ). Seventeen states have all-payer claims system that mandate payer submission of claims and 11 states have data systems that are voluntary ( All-Payer Claims Database Council, 2009 –2020).…”

Opioid analgesic prescribing for opioid‐naïve individuals prior to identification of opioid use disorder in British Columbia, Canada

“…is unlikely that opioid analgesics were the primary factor in development of OUD in all cases, our findings suggest that opioid analgesic prescriptions may have contributed to nearly a third of all OUD cases identified between 2001 and 2018. In a study of initial opioid analgesic prescriptions in Massachusetts, Burke et al [20] found that strength of initial prescription, concurrent benzodiazepine prescription and long-term treatment declined from 2011 to 2014. Our study adds a population-based examination of initial opioid analgesic prescriptions and guideline concordance by prescription source in a unique Canadian setting from 2001 to 2018.…”

“…Moreover, long-term and high-dose prescriptions are known to contribute to the misuse of opioids [18] and overdose risk [19]. There is evidence that concurrent benzodiazepine treatment and longer durations of initial opioid therapy are associated with higher rates of OUD and overdose [20], and that the probability of long-term use increases sharply during the first 5 days of therapy [21]. Thus, initial prescriptions are identified as key points of intervention to prevent opioid-related harms [22].…”

Demographic Pattern and Mortality Risk Factors for Prescription Opioid Overdose Hospitalizations: Results From Nationwide Inpatient Sample Analysis

“…Based on the agency for healthcare research and quality, opioid-related hospitalizations have increased by 64% between 2005 and 2014 in the United States [4]. Although the incidence of opioid use disorders in adults receiving prescriptions of opioids has drastically decreased in the past few years, rates of both fatal and nonfatal opioid overdose remain unchanged [5].…”