Patterns of Initial Opioid Prescribing to Opioid-Naive Patients
| Autor: | Michael J. Englesbe, Hsou-Mei Hu, Romesh P. Nalliah, Chad M. Brummett, Daniel B. Larach, Jay S. Lee, Jennifer F. Waljee |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Cross-sectional study Pain medicine Article 03 medical and health sciences 0302 clinical medicine medicine Humans Practice Patterns Physicians' Medical prescription Practice Patterns Dentists' Retrospective Studies Surgeons business.industry Chronic pain Retrospective cohort study Middle Aged medicine.disease United States Analgesics Opioid Cross-Sectional Studies Hydrocodone Opioid 030220 oncology & carcinogenesis Emergency medicine Female 030211 gastroenterology & hepatology Surgery Emergency Service Hospital business Oxycodone medicine.drug |
| Zdroj: | Ann Surg |
| ISSN: | 1528-1140 0003-4932 |
| Popis: | OBJECTIVE: To determine the episodes of care during which opioid-naïve patients receive initial opioid prescriptions. We hypothesized that the percentage of prescriptions to surgical, emergency medicine, and dental patients increased as new primary care and pain medicine opioid prescribing guidelines were developed. SUMMARY BACKGROUND DATA: Most opioid-related morbidity and mortality derives from prescribed opioids or from nonmedical opioid misuse and abuse stemming from prescription use. Although guidelines exist for opioid prescribing in the setting of chronic use, much less is known regarding the types of care for which opioid-naïve patients are provided an initial opioid prescription. METHODS: Retrospective cross-sectional study over 2010–2016 using a nationwide insurance claims dataset to study US adults aged 18 to 64 years. The primary outcome was change in opioid prescriptions for opioid-naïve patients undergoing surgical, emergency, and dental care from 2010 to 2016, and the type and amounts of opioid filled. RESULTS: We identified 16,292,018 opioid prescriptions filled by opioid-naïve patients. The combined share of prescriptions for patients receiving surgery, emergency, and dental care increased by 15.8% from 2010 to 2016. In 2016, surgery patients filled 22.0% of initial prescriptions, emergency medicine patients 13.0%, and dental patients 4.2%; surgical patients received the most total (403 mg oral morphine equivalents, SD 1369) and daily (82 mg oral morphine equivalents, SD 273) opioid amounts, and the second-highest number of days of opioid per prescription (5.4, SD 3.4). Surgical patients’ mean total oral morphine equivalents per prescription increased from 240 mg (SD 509) in 2010 to 403 mg (SD 1369) in 2016. Over the study period, surgical patients received the highest proportion of potent opioids (90.2%). CONCLUSIONS: Initial opioid prescribing attributable to dental, emergency, and surgical care is increasing relative to primary and chronic pain care, possibly due to the advent of opioid prescribing guidelines for primary care and pain physicians. These data emphasize the importance of developing prescribing guidelines for these episodes of care, during which the highest amounts of opioids are prescribed to opioid-naïve patients. |
| Databáze: | OpenAIRE |
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