Dataset Information

Population- and individual-level trajectories of opioid prescription patterns among adults with cerebral palsy: a retrospective cohort study.

ABSTRACT:

Background

There is little epidemiologic evidence on opioid prescription among adults with cerebral palsy (CP).

Aim

To describe the population- and individual-level opioid prescription patterns for adults with versus without CP.

Method

This retrospective cohort study used commercial claims (Optum's de-identified Clinformatics® Data Mart Database) from the USA from 01/01/2011-12/31/2017 from adults ≥ 18 years old with CP and matched adults without CP. For the population-level analysis, monthly estimates of opioid exposure were described for adults ≥ 18 years old with CP and matched adults without CP. For the individual-level analysis, group based trajectory modelling (GBTM) was used to identify groups of similar individual-level monthly opioid exposure patterns for adults with CP and matched adults without CP for 1-year starting from their first opioid exposure month.

Results

For the population-level, adults with (n = 13,929) versus without (n = 278,538) CP had a higher prevalence of opioid exposure (~ 12%, ~ 8%) and days supplied (median, ~ 23, ~17) monthly over 7 years. For the individual-level, there were 6 trajectory groups for CP (n = 2099) and 5 for non-CP (n = 10,361). Notably, 14% of CP (comprising 4 distinct trajectory groups) and 8% (comprising 3 distinct groups) of non-CP had variably high monthly opioid volume for extended periods; exposure was higher for CP. The remaining had low/absent opioid exposure trajectories; for CP (non-CP), 55.7% (63.3%) had nearly absent exposure and 30.4% (28.9%) had consistently low exposure to opioids.

Conclusion

Adults with versus without CP were more likely to be exposed to opioids and for a longer duration, which may alter the risk-benefit balance of opioids.

SUBMITTER: Whitney DG

PROVIDER: S-EPMC9999316 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

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Publications

Population- and individual-level trajectories of opioid prescription patterns among adults with cerebral palsy: a retrospective cohort study.

Whitney Daniel G DG Peterson Mark D MD Hurvitz Edward A EA

International journal of clinical pharmacy 20230310 3

<h4>Background</h4>There is little epidemiologic evidence on opioid prescription among adults with cerebral palsy (CP).<h4>Aim</h4>To describe the population- and individual-level opioid prescription patterns for adults with versus without CP.<h4>Method</h4>This retrospective cohort study used commercial claims (Optum's de-identified Clinformatics® Data Mart Database) from the USA from 01/01/2011-12/31/2017 from adults ≥ 18 years old with CP and matched adults without CP. For the population-leve ...[more]

PMID: 36897434

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Project description:ImportanceAlthough prescription opioids are the most common way adolescents and young adults initiate opioid use, many studies examine population-level risks following the first opioid prescription. There is currently a lack of understanding regarding how patterns of opioid prescribing following the first opioid exposure may be associated with long-term risks.ObjectiveTo identify distinct patterns of opioid prescribing following the first prescription using group-based trajectory modeling and examine the patient-, clinician-, and prescription-level factors that may be associated with trajectory membership during the first year.Design, setting, and participantsThis cohort study examined Pennsylvania Medicaid enrollees' claims data from 2010 through 2016. Participants were aged 10 to 21 years at time of first opioid prescription. Data analysis was performed in March 2020.Main outcomes and measuresThis study used group-based trajectory modeling and defined trajectory status by opioid fill.ResultsAmong the 189 477 youths who received an initial opioid prescription, 107 562 were female (56.8%), 81 915 were non-Latinx White (59.6%), and the median age was 16.9 (interquartile range [IQR], 14.6-18.8) years. During the subsequent year, 47 477 (25.1%) received at least one additional prescription. Among the models considered, the 2-group trajectory model had the best fit. Of those in the high-risk trajectory, 65.3% (n = 901) filled opioid prescriptions at month 12, in contrast to 13.1% (n = 6031) in the low-risk trajectory. Median age among the high-risk trajectory was 19.0 years (IQR, 17.1-20.0 years) compared with the low-risk trajectory (17.8 years [IQR, 15.8-19.4 years]). The high-risk trajectory received more potent prescriptions compared with the low-risk trajectory (median dosage of the index month for high-risk trajectory group: 10.0 MME/d [IQR, 5.0-21.2 MME/d] vs the low-risk trajectory group: 4.7 MME/d [IQR, 2.5-7.8 MME/d]; P < .001). The trajectories showed persistent differences with more youths in the high-risk trajectory going on to receive a diagnosis of opioid use disorder (30.0%; n = 412) compared with the low-risk group (10.1%; n = 4638) (P < .001).Conclusions and relevanceThis study's results identified 2 trajectories associated with elevated risk for persistent opioid receipt within 12 months following first opioid prescription. The high-risk trajectory was characterized by older age at time of first prescription, and longer and more potent first prescriptions. These findings suggest even short and low-dose opioid prescriptions can be associated with risks of persistent use for youths.

Project description:ImportanceSafe opioid prescribing practices are critical to mitigate the risk of prescription opioid overdose in adolescents and young adults. However, studies that examine opioid prescribing patterns associated with prescription opioid overdose have mostly focused on older adults. The generalizability of these studies to adolescents and young adults is unclear.ObjectiveTo identify opioid prescribing patterns associated with prescription opioid overdose in adolescents and young adults.Design, setting, and participantsThis retrospective cohort study assessed privately insured patients aged 12 to 21 years with opioid prescription claims in the IBM MarketScan Commercial Claims and Encounters database between July 1, 2009, and October 1, 2017, and no cancer diagnosis. Data analysis was performed from January 1 to April 30, 2019.Main outcomes and measuresThe outcome was a treated opioid overdose as indicated by diagnosis codes. On the basis of days supplied, opioid prescription claims were converted to person-days (the unit of analysis) on which opioid exposure would occur if patients took medications as prescribed. Logistic regression with clustered SEs at the patient level was used to model the occurrence of overdose on a person-day as a function of daily opioid dosage category (<30, 30-59, 60-89, 90-119, or ≥120 morphine milligram equivalents), concurrent benzodiazepine use, and extended-release or long-acting opioid use. Regressions controlled for demographic characteristics, year, opioid use within 180 days, and comorbidities (mental health disorder, substance use disorder, and other chronic condition).ResultsA total of 2 752 612 patients (mean [SD] age at cohort entry, 17.2 [2.5] years; 1 451 918 [52.8%] female) participated in the study. Patients had 4 686 355 opioid prescription claims, corresponding to 21 605 444 person-days. Overdose occurred on 255 person-days among 249 patients (0.01% of the sample). Each increase in daily opioid dosage category was associated with higher overdose risk (adjusted odds ratio [AOR], 1.18; 95% CI, 1.05-1.31). Compared with no use, both concurrent benzodiazepine use (AOR, 1.83; 95% CI, 1.24-2.71) and extended-release or long-acting opioid use (AOR, 2.01; 95% CI, 1.16-3.46) were associated with increased overdose risk.Conclusions and relevanceThe findings suggest that when prescribing opioids to adolescents and young adults, practitioners could potentially mitigate overdose risk by using the lowest effective daily dosage, avoiding concurrent opioid and benzodiazepine prescribing, and relying on short-acting opioids. Findings are broadly consistent with prior opioid safety studies focused on older adults.

Project description:ImportanceThere are known risks of using opioids for extended periods. However, less is known about the long-term trajectories of opioid use following initiation.ObjectiveTo identify 5-year trajectories of prescription opioid use, and to examine the characteristics of each trajectory group.Design, setting, and participantsThis population-based cohort study conducted in New South Wales, Australia, linked national pharmaceutical claims data to 10 national and state data sets to determine sociodemographic characteristics, clinical characteristics, drug use, and health services use. The cohort included adult residents (aged ≥18 years) of New South Wales who initiated a prescription opioid between July 1, 2003, and December 31, 2018. Statistical analyses were conducted from February to September 2022.ExposureDispensing of a prescription opioid, with no evidence of opioid dispensing in the preceding 365 days, identified from pharmaceutical claims data.Main outcomes and measuresThe main outcome was the trajectories of monthly opioid use over 60 months from opioid initiation. Group-based trajectory modeling was used to classify these trajectories. Linked health care data sets were used to examine characteristics of individuals in different trajectory groups.ResultsAmong 3 474 490 individuals who initiated a prescription opioid (1 831 230 females [52.7%]; mean [SD] age, 49.7 [19.3] years), 5 trajectories of long-term opioid use were identified: very low use (75.4%), low use (16.6%), moderate decreasing to low use (2.6%), low increasing to moderate use (2.6%), and sustained use (2.8%). Compared with individuals in the very low use trajectory group, those in the sustained use trajectory group were older (age ≥65 years: 22.0% vs 58.4%); had more comorbidities, including cancer (4.1% vs 22.2%); had increased health services contact, including hospital admissions (36.9% vs 51.6%); had higher use of psychotropic (16.4% vs 42.4%) and other analgesic drugs (22.9% vs 47.3%) prior to opioid initiation, and were initiated on stronger opioids (20.0% vs 50.2%).Conclusions and relevanceResults of this cohort study suggest that most individuals commencing treatment with prescription opioids had relatively low and time-limited exposure to opioids over a 5-year period. The small proportion of individuals with sustained or increasing use was older with more comorbidities and use of psychotropic and other analgesic drugs, likely reflecting a higher prevalence of pain and treatment needs in these individuals.

Project description:BackgroundAdolescent misuse of prescription opioids is hazardous. This study aimed to generate data on prescription opioid misuse trajectories across adolescence and identify risk factors and mechanisms for more dangerous use trajectories.MethodsUsing a prospective longitudinal cohort repeated measures design, baseline (Fall 2013) and seven semiannual assessments were administered through Spring 2017 in 10 public high schools in Los Angeles, CA. Frequency of past 30-day prescription opioid misuse was captured. Trajectory groups were identified using growth mixture modeling and multinomial logistic regression identified associations between baseline risk factors with membership in each trajectory group.ResultsOverall, 3395 students were evaluated (53.4% female, Mean [SD] age at baseline=14.58[0.40]; range=12.83-16.29). Four discrete misuse trajectories were identified among 1062 students: (1) Minimal/Experimental (infrequent time-limited use; range of estimated mean number of days using prescription opioid across waves=0.0-0.6 days]; N = 705[20.8%]); (2) Low Deescalating (range=2.0-0.7 days; N = 189[5.6%]); (3) Moderate Escalating (range=0.7-3.6 days; N = 108[3.2%]); and (4) Frequent Persistent (range=4.7-9.4 days; N = 60[1.8%]). Students reporting tobacco, cannabis, alcohol use, or impulsivity in 9th grade were more likely to demonstrate membership in the Moderate Escalating trajectory class when compared to 2333 (68.7%) students reporting sustained abstinence. Female sex, peer opioid misuse, alcohol use, other substance use, impulsivity, or delinquent behavior reported in 9th grade was associated with membership in the Frequent Persistent trajectory class.ConclusionsPrescription opioid misuse in adolescence appears to follow 4 discrete trajectories, including the potentially problematic Moderate Escalating and Frequent Persistent trajectories. Female sex, peer influences, substance use, and intrapersonal risk factors were associated with membership in these classes.

Dataset Information

Population- and individual-level trajectories of opioid prescription patterns among adults with cerebral palsy: a retrospective cohort study.

Background

Aim

Method

Results

Conclusion

Publications

Population- and individual-level trajectories of opioid prescription patterns among adults with cerebral palsy: a retrospective cohort study.

Similar Datasets

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