Transitions Within Opioid Therapy and Their Impact on Morbidity, Healthcare Utilization, and Costs
Year: 2017
Type: dissertation
Study design: Observational Study
Abstract: In the United States (US), chronic non-cancer pain (CNCP) is prevalent among adults with costs exceeding half a billion dollars annually and can be especially burdensome for working age adults due to lost productivity and negative impacts on quality of life.An estimated 43% of adults experience pain, and the majority of them are working age (22--64 years). Despite lack of robust evidence on the efficacy and effectiveness of opioids relieving CNCP, and currently-available effective non-opioid treatments, many patients still receive opioid therapy. Opioids are associated with significant negative health consequences up to and including addiction to opioids which further increases their risk for overdose and death.10 Effective clinical, policy, and community responses to solve the opioid epidemic focus on a continuum beginning with appropriate initiation of opioids and ending with harm reduction efforts. The first step is the appropriate initiation of opioids because as many as 46% of adults who were initiated on opioids transition into chronic opioid users. Chronic opioid therapy (COT) can exacerbate current conditions and lead to development of new chronic physical and mental health conditions, and other opioid-related adverse effects including overdose. These negative consequences related to opioids lead to high economic burden through increased emergency room, inpatient, and other healthcare utilization and healthcare expenditures. Analysis of COT and its economic burden is especially important among working-age adults who receive opioids more frequently when they experience pain.;This study was conducted to (1) assess factors which predict the transition to COT, (2) estimate the changes in healthcare utilization and expenditure associated with the transition to COT, and (3) to identify educational strategies that can be used to fill knowledge gaps about opioids, naloxone, and opioid use disorder treatment medications for a group of healthcare professionals who are well suited to help alleviate the opioid epidemic.;First, we identified leading predictors associated with incident COT among adults without cancer in the US using a 10% random sample of working-age adults (age 28--63 years) insured in commercial plans, who were initiated on opioids between January 2007 through May 2015. The four leading predictors of COT were opioid duration-of-action [AOR= 12.28; 95%CI= 8.06-18.72], parent opioid tramadol vs. codeine, [AOR= 7.26; 95%CI= 5.20-10.13], the presence of conditions highly likely to cause chronic pain [AOR= 5.47; 95%CI=3.89-7.68] and drug use disorders [AOR= 4.02; 95%CI= 2.53-6.40]. Next, using the same data source, we assessed the association between transitioning from incident opioid use to chronic
DOI: 10.33915/etd.6804
Author: James Douglas Thornton
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4241977013