Incident and long-term opioid therapy among patients with psychiatric conditions and medications: A national study of commercial health care claims

Patrick D. Quinn, Kwan Hur, Zheng Chang, Erin E. Krebs, Matthew J. Bair, Eric L. Scott, Martin E. Rickert, Robert D. Gibbons, Kurt Kroenke, Brian M. D'Onofrio

Research output: Contribution to journalArticle

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Abstract

There is growing evidence that opioid prescribing in the United States follows a pattern in which patients who are at the highest risk of adverse outcomes from opioids are more likely to receive long-term opioid therapy. These patients include, in particular, those with substance use disorders (SUDs) and other psychiatric conditions. This study examined health insurance claims among 10,311,961 patients who filled prescriptions for opioids. Specifically, we evaluated how opioid receipt differed among patients with and without a wide range of preexisting psychiatric and behavioral conditions (ie, opioid and nonopioid SUDs, suicide attempts or other self-injury, motor vehicle crashes, and depressive, anxiety, and sleep disorders) and psychoactive medications (ie, antidepressants, benzodiazepines, hypnotics, mood stabilizers, antipsychotics, and medications used for SUD, tobacco cessation, and attention-deficit/hyperactivity disorder). Relative to those without, patients with all assessed psychiatric conditions and medications had modestly greater odds of subsequently filling prescriptions for opioids and, in particular, substantially greater risk of long-term opioid receipt. Increases in risk for long-term opioid receipt in adjusted Cox regressions ranged from approximately 1.5-fold for prior attention-deficit/hyperactivity disorder medication prescriptions (hazard ratio [HR] = 1.53; 95% confidence interval [CI], 1.48-1.58) to approximately 3-fold for prior nonopioid SUD diagnoses (HR = 3.15; 95% CI, 3.06-3.24) and nearly 9-fold for prior opioid use disorder diagnoses (HR = 8.70; 95% CI, 8.20-9.24). In sum, we found evidence of greater opioid receipt among commercially insured patients with a breadth of psychiatric conditions. Future studies assessing behavioral outcomes associated with opioid prescribing should consider preexisting psychiatric conditions.

LanguageEnglish (US)
Pages140-148
Number of pages9
JournalPain
Volume158
Issue number1
DOIs
StatePublished - Jan 1 2017

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Opioid Analgesics
Psychiatry
Delivery of Health Care
Substance-Related Disorders
Therapeutics
Prescriptions
Confidence Intervals
Attention Deficit Disorder with Hyperactivity
Tobacco Use Cessation
Preexisting Condition Coverage
Motor Vehicles
Health Insurance
Depressive Disorder
Anxiety Disorders
Hypnotics and Sedatives
Benzodiazepines
Suicide
Antidepressive Agents
Antipsychotic Agents

Keywords

  • Adverse selection
  • Epidemiology
  • Health insurance claims
  • Prescription opioid analgesics

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

Cite this

Incident and long-term opioid therapy among patients with psychiatric conditions and medications : A national study of commercial health care claims. / Quinn, Patrick D.; Hur, Kwan; Chang, Zheng; Krebs, Erin E.; Bair, Matthew J.; Scott, Eric L.; Rickert, Martin E.; Gibbons, Robert D.; Kroenke, Kurt; D'Onofrio, Brian M.

In: Pain, Vol. 158, No. 1, 01.01.2017, p. 140-148.

Research output: Contribution to journalArticle

Quinn, PD, Hur, K, Chang, Z, Krebs, EE, Bair, MJ, Scott, EL, Rickert, ME, Gibbons, RD, Kroenke, K & D'Onofrio, BM 2017, 'Incident and long-term opioid therapy among patients with psychiatric conditions and medications: A national study of commercial health care claims' Pain, vol 158, no. 1, pp. 140-148. DOI: 10.1097/j.pain.0000000000000730
Quinn, Patrick D. ; Hur, Kwan ; Chang, Zheng ; Krebs, Erin E. ; Bair, Matthew J. ; Scott, Eric L. ; Rickert, Martin E. ; Gibbons, Robert D. ; Kroenke, Kurt ; D'Onofrio, Brian M./ Incident and long-term opioid therapy among patients with psychiatric conditions and medications : A national study of commercial health care claims. In: Pain. 2017 ; Vol. 158, No. 1. pp. 140-148
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abstract = "There is growing evidence that opioid prescribing in the United States follows a pattern in which patients who are at the highest risk of adverse outcomes from opioids are more likely to receive long-term opioid therapy. These patients include, in particular, those with substance use disorders (SUDs) and other psychiatric conditions. This study examined health insurance claims among 10,311,961 patients who filled prescriptions for opioids. Specifically, we evaluated how opioid receipt differed among patients with and without a wide range of preexisting psychiatric and behavioral conditions (ie, opioid and nonopioid SUDs, suicide attempts or other self-injury, motor vehicle crashes, and depressive, anxiety, and sleep disorders) and psychoactive medications (ie, antidepressants, benzodiazepines, hypnotics, mood stabilizers, antipsychotics, and medications used for SUD, tobacco cessation, and attention-deficit/hyperactivity disorder). Relative to those without, patients with all assessed psychiatric conditions and medications had modestly greater odds of subsequently filling prescriptions for opioids and, in particular, substantially greater risk of long-term opioid receipt. Increases in risk for long-term opioid receipt in adjusted Cox regressions ranged from approximately 1.5-fold for prior attention-deficit/hyperactivity disorder medication prescriptions (hazard ratio [HR] = 1.53; 95{\%} confidence interval [CI], 1.48-1.58) to approximately 3-fold for prior nonopioid SUD diagnoses (HR = 3.15; 95{\%} CI, 3.06-3.24) and nearly 9-fold for prior opioid use disorder diagnoses (HR = 8.70; 95{\%} CI, 8.20-9.24). In sum, we found evidence of greater opioid receipt among commercially insured patients with a breadth of psychiatric conditions. Future studies assessing behavioral outcomes associated with opioid prescribing should consider preexisting psychiatric conditions.",
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AB - There is growing evidence that opioid prescribing in the United States follows a pattern in which patients who are at the highest risk of adverse outcomes from opioids are more likely to receive long-term opioid therapy. These patients include, in particular, those with substance use disorders (SUDs) and other psychiatric conditions. This study examined health insurance claims among 10,311,961 patients who filled prescriptions for opioids. Specifically, we evaluated how opioid receipt differed among patients with and without a wide range of preexisting psychiatric and behavioral conditions (ie, opioid and nonopioid SUDs, suicide attempts or other self-injury, motor vehicle crashes, and depressive, anxiety, and sleep disorders) and psychoactive medications (ie, antidepressants, benzodiazepines, hypnotics, mood stabilizers, antipsychotics, and medications used for SUD, tobacco cessation, and attention-deficit/hyperactivity disorder). Relative to those without, patients with all assessed psychiatric conditions and medications had modestly greater odds of subsequently filling prescriptions for opioids and, in particular, substantially greater risk of long-term opioid receipt. Increases in risk for long-term opioid receipt in adjusted Cox regressions ranged from approximately 1.5-fold for prior attention-deficit/hyperactivity disorder medication prescriptions (hazard ratio [HR] = 1.53; 95% confidence interval [CI], 1.48-1.58) to approximately 3-fold for prior nonopioid SUD diagnoses (HR = 3.15; 95% CI, 3.06-3.24) and nearly 9-fold for prior opioid use disorder diagnoses (HR = 8.70; 95% CI, 8.20-9.24). In sum, we found evidence of greater opioid receipt among commercially insured patients with a breadth of psychiatric conditions. Future studies assessing behavioral outcomes associated with opioid prescribing should consider preexisting psychiatric conditions.

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