Use of Drug Claims Data and a Medication Risk Score to Assess the Impact of CYP2D6 Drug Interactions among Opioid Users on Healthcare Costs

Abstract

Cytochrome P450 2D6 (CYP2D6) activity is highly variable due to several factors, including genetic polymorphisms and drug-drug-gene interactions. Hydrocodone, oxycodone, codeine, and tramadol the most commonly prescribed CYP2D6-activated opioids for pain. However, the co-administration of CYP2D6 interacting drugs can modulate CYP2D6-medicated activation of these opioids, affecting drug analgesia, effectiveness, and safety, and can impact healthcare costs. A retrospective, observational cohort analysis was performed in a large (n = 50,843) adult population. This study used drug claims data to derive medication risk scores and matching propensity scores to estimate the effects of opioid use and drug-drug interactions (DDIs) on medical expenditures. 4088 individuals were identified as opioid users; 95% of those were prescribed CYP2D6-activated opioids. Among those, 15% were identified as being at risk for DDIs. Opioid users had a significant increase in yearly medical expenditure compared to non-opioid users ($2457 vs. $1210). In matched individuals, average healthcare expenditures were higher for opioid users with DDIs compared to those without DDIs ($7841 vs. $5625). The derived medication risk score was higher in CYP2D6 opioid users with interacting drug(s) compared to no DDI (15 vs. 12). Higher costs associated with CYP2D6 opioid use under DDI conditions suggest inadequate CYP2D6 opioid prescribing practices. Efforts to improve chronic opioid use in adults should reduce interacting drug combinations, especially among patients using CYP2D6 activated opioids.

High opioid doses, naloxone, and central nervous system active medications received by Medicare‐enrolled adults

“… 1 , 2 , 11 , 12 , 13 , 14 , 15 Additionally, approximately 15% of patients receiving opioids were found to be at risk of experiencing a drug–drug interaction resulting in increased dose requirements for adequate pain control. 27 …”

“…1,2,[11][12][13][14][15] Additionally, approximately 15% of patients receiving opioids were found to be at risk of experiencing a drug-drug interaction resulting in increased dose requirements for adequate pain control. 27 Greater use of SNRIs among patients with chronic opioid use at higher doses was expected given SNRIs are used to treat chronic pain, neuropathic pain, and central pain sensitization. 1,28 However, psychotropic drugs and psychiatric diagnoses are individual risk factors for opioid misuse and opioid overdose.…”

“…Patients with chronic opioid use who utilize hypnotics, SMRs, gabapentanoids, and benzodiazepines are at greater risk of opioid overdose and mortality 1,2,11–15 . Additionally, approximately 15% of patients receiving opioids were found to be at risk of experiencing a drug–drug interaction resulting in increased dose requirements for adequate pain control 27 …”

Reply to: Commentary on: Pharmacist‐driven interventions to de‐escalate urinary antimuscarinics in the Programs of All‐Inclusive Care for the Elderly

“…4 CYP2D6 interactions are relevant because (1) several common medications are CYP2D6 substrates (e.g., antidepressants, antipsychotics, opioids, urinary antimuscarinics), and (2) they are costly and potentially fatal. 4,5 In fact, CYP2D6 interactions account for 35% of all CYP450-mediated drug interactions identified by PACE pharmacists. 6 At the study's practice site, the MedWise Risk Score (MRS) helps pharmacists quantify the risk of such interactions.…”