Trends of Opioid Use Disorder Among Hospitalized Patients With Chronic Pain

Abstract

Background Patients with chronic pain treated with opioids are at an increased risk for opioid misuse or opioid use disorder (OUD). Recent years have seen a stark increase in abuse, misuse, and diversion of prescription opioid medications. The aim of this study was to investigate trends in changing rates of opioid use disorder among patients with chronic pain. Methods The National Inpatient Sample (NIS) database identified chronic pain admissions with OUD from 2011 to 2015. Patients were identified from the NIS database using International Classification of Diseases (9th and 10th revisions) diagnosis codes for chronic pain and OUD. Annual estimates and trends were determined for OUD, patient characteristics, OUD among subgroups of chronic pain conditions, and discharge diagnosis. Results We identified 10.3 million patients with chronic pain. Of these, 680,631 patients were diagnosed with OUD. The number of patients with OUD increased from 109,222 in 2011 to 172,680 in 2015 (P < 0.001). Similarly, there were upward trends of OUD among females (53.2% to 54.5%; P = 0.09), patients 65 to 84 years of age (11.8% to 17%; P < 0.001), Medicare‐insured patients (39.5% to 46.0%; P < 0.01), patients with low annual household incomes (27.8% to 33.3%; P < 0.001), and patients with cannabinoid use disorder (7.2% to 8.3%; P = 0.01). The prevalence of OUD increased from 2011 to 2015 in patients with chronic regional pain syndrome (5.53% to 7.46%; P = 0.01) and spondylosis (1.32% to 1.81%; P < 0.001). Conclusions These findings suggest that the prevalence of OUD increased substantially from 2011 to 2015. Disparities of OUD with increasing opioid use among vulnerable populations including women, those with Medicare insurance, tobacco use disorder, and low annual income should be explored further.

Healthcare Resource Use and Costs Associated with Opioid Initiation Among Patients with Newly Diagnosed Endometriosis with Commercial Insurance in the USA

“…Out of the initial 85,329 female patients with newly diagnosed endometriosis, 71.5% were opioid users and 28.5% were non-opioid users. In comparison, patients diagnosed with other diseases reported lower percentages of opioid use: complex regional pain syndrome (7.5%), trauma (13.9%), post-surgical (6.9%), spondylosis (1.8%), failed back surgery syndrome (4.6%), and other chronic pain (7.3%) [30,31]. Another study reported that a third of patients received an opioid prescription within 6 weeks for acute low back pain [31].…”

“…The index date for patients with opioid use in this study was their first opioid prescription date after endometriosis diagnosis, while As-Sanie used the endometriosis diagnosis date. It was reported that patients with endometriosis have the highest costs in the first year after diagnosis, partly due to more surgeries in the year after diagnosis [30]. Second, there are prominent differences between the matched populations used for analysis in these two studies.…”

Geographic Variation in the Use of Gabapentinoids and Opioids for Pain in a Commercially Insured Adult Population in the United States

“…We included beneficiaries aged ≥18 years with continuous insurance enrollment between December 1, 2017, and December 1, 2018 ( eFigure 1 in the Supplement ). We excluded patients diagnosed with epilepsy 13 , 14 or opioid use disorder (OUD) 15 between December 1, 2017, and December 1, 2018 ( eTable 1 ). We assumed that gabapentinoids and/or opioids were for pain management.…”

Patterns of Inpatient Opioid Use and Related Adverse Events Among Patients With Cirrhosis: A Propensity‐Matched Analysis

“…In an effort to understand whether patients were likely to receive opioids because of chronic or outpatient use, we identified the proportion of patients with one of four ICD-10-CM diagnosis codes for chronic pain that have been validated in the literature. (20) We also identified patients with one of 143 opioid-related ICD-10-CM diagnosis codes either for opioid abuse or opioid poisoning, as defined by the AHRQ. (21) seRious opioiD-RelateD aDVeRse eVents…”