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Incidence and Risk Factors for Progression From Short-term to Episodic or Long-term Opioid Prescribing: A Population-Based Study

Mayo Clinic Proceedings, Volume 90, Issue 7, July 2015, Pages 850 - 856

Abstract

Objectives

To determine what proportion of a geographically defined population who receive new opioid prescriptions progresses to episodic or long-term patterns of opioid prescribing and to explore the clinical characteristics associated with patterns of opioid prescribing.

Patients and Methods

Population-based drug prescription records for the population of Olmsted County between January 1 and December 31, 2009, were obtained using the Rochester Epidemiology Project medical records linkage system (N=142,377). All medical records were reviewed for a random sample of 293 patients who had a new (“incident”) prescription for an opioid analgesic in 2009. Patients were followed through their medical records for 1 year after their initial prescription date, with patterns of opioid prescribing categorized as short-term, episodic, or long-term.

Results

Overall, 293 patients received 515 new opioid prescriptions in 2009. Of these, 61 (21%) progressed to an episodic prescribing pattern and 19 (6%) progressed to a long-term prescribing pattern. In multivariable logistic regression analyses, substance abuse was significantly associated (P<.001) with a long-term opioid prescribing pattern as compared with an short-term opioid prescribing pattern. Past or current nicotine use (P=.03) and substance abuse (P=.04) were significantly associated with an episodic or long-term prescribing pattern as compared with a short-term prescribing pattern.

Conclusion

Knowledge of the clinical characteristics associated with the progression of a short-term to an episodic or long-term opioid prescribing pattern could aid in the identification of at-risk patients and provide the basis for developing targeted clinical interventions.

Abbreviations and Acronyms: CCI - Charlson Comorbidity Index, CONSORT - Consortium to Study Opioid Risks and Trends, mPFC - medial prefrontal cortex, OR - odds ratio, PTSD - posttraumatic stress disorder, REP - Rochester Epidemiology Project.

Footnotes

a Department of Anesthesiology, Mayo Clinic, Rochester, MN

b Division of Epidemiology, Department of Health Sciences Research, the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN

c Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN

Correspondence: Address to W. Michael Hooten, MD, Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

Grant Support: This study was made possible by the Rochester Epidemiology Project (grant number R01-AG034676; Principal Investigator: Walter A. Rocca, MD, MPH, and Barbara P. Yawn, MD, MSc).