Opioid tolerance and urine drug testing among initiates of extended-release or long-acting opioids in Food and Drug Administration's Sentinel System.

Autor:	Larochelle MR; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Section of General Internal Medicine, Boston, Massachusetts., Cocoros NM; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts., Popovic J; Program for Health Data and Standardized Methods, RTI International, Waltham, Massachusetts., Dee EC; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts., Kornegay C; Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland., Ju J; Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland., Racoosin JA; Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland.
Jazyk:	angličtina
Zdroj:	Journal of opioid management [J Opioid Manag] 2017 Sep/Oct; Vol. 13 (5), pp. 315-327.
DOI:	10.5055/jom.2017.0400
Abstrakt:	Objective: A risk evaluation and mitigation strategy for extended-release and long-acting (ER/LA) opioid analgesics was approved by the Food and Drug Administration in 2012. Our objective was to assess frequency of opioid tolerance and urine drug testing for individuals initiating ER/LA opioid analgesics. Design: Retrospective cohort study. Setting: Sentinel, a distributed database with electronic healthcare data on >190 million predominantly commercially insured members. Patients, Participants: Members under age 65 initiating ER/LA opioid analgesics between January 2009 and December 2013. Main Outcome Measure(s): We examined the proportion of opioid-tolerant-only ER/LA opioid analgesic initiates meeting tolerance criteria: receipt of ≥30 mg oxycodone equivalents per day in 7 days prior to the first opioid-tolerant-only dispensing. We separately examined the proportion of new users of extended-release oxycodone (ERO) and other ER/LA opioid analgesics with a claim for a urine drug test in the 30 days prior to, and separately for the 183 days after, dispensing. Results: We identified 79,824 ERO, 7,343 extended-release hydromorphone, and 91,778 transdermal fentanyl opi-oid-tolerant-only episodes. Tolerance criteria were met in 64 percent of ERO, 64 percent of extended-release hydromorphone and 40 percent of transdermal fentanyl episodes. We identified 210,581 incident ERO and 311,660 other ER/LA opioid analgesic episodes. Use of urine drug testing for ERO compared with other ER/LA opioid analgesics was: 4 percent vs 14 percent respectively in the 30 days prior to initiation and 9 percent vs 23 percent respectively in the 183 days following initiation. Conclusions: These results suggest potential areas for improving appropriate ER/LA opioid analgesic prescribing practices.
Databáze:	MEDLINE
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