Longitudinal dose patterns among patients newly initiated on long-term opioid therapy in the United States, 2018 to 2019: an observational cohort study and time-series cluster analysis

Details

• Alternative Title:
  Pain
• Personal Author:
  Rikard, S. Michaela ; Nataraj, Nisha ; Zhang, Kun ; Strahan, Andrea E. ; Mikosz, Christina A. ; Guy, Gery P.
• Description:
  Opioid prescribing varies widely, and prescribed opioid dosages for an individual can fluctuate over time. Patterns in daily opioid dosage among patients prescribed long-term opioid therapy have not been previously examined. This study uses a novel application of time-series cluster analysis to characterize and visualize daily opioid dosage trajectories and associated demographic characteristics of patients newly initiated on long-term opioid therapy. We used 2018 to 2019 data from the IQVIA Longitudinal Prescription (LRx) all-payer pharmacy database, which covers 92% of retail pharmacy prescriptions dispensed in the United States. We identified a cohort of 277,967 patients newly initiated on long-term opioid therapy during 2018. Patients were stratified into 4 categories based on their mean daily dosage during a 90-day baseline period (<50, 50-89, 90-149, and ≥150 morphine milligram equivalent [MME]) and followed for a 270-day follow-up period. Time-series cluster analysis identified 2 clusters for each of the 3 baseline dosage categories <150 MME and 3 clusters for the baseline dosage category ≥150 MME. One cluster in each baseline dosage category comprised opioid dosage trajectories with decreases in dosage at the end of the follow-up period (80.7%, 98.7%, 98.7%, and 99.0%, respectively), discontinuation (58.5%, 80.0%, 79.3%, and 81.7%, respectively), and rapid tapering (50.8%, 85.8%, 87.5%, and 92.9%, respectively). These findings indicate multiple clusters of patients newly initiated on long-term opioid therapy who experience discontinuation and rapid tapering and highlight potential areas for clinician training to advance evidence-based guideline-concordant opioid prescribing, including strategies to minimize sudden dosage changes, discontinuation, or rapid tapering, and the importance of shared decision-making.
• Subjects:
  Analgesics, Opioid Cluster Analysis Cohort Studies Humans Practice Patterns, Physicians' Retrospective Studies United States
• Keywords:
  Cluster Analysis Long-term Opioid Therapy Opioid Prescribing
• Source:
  Pain. 164(12):2675-2683
• Pubmed ID:
  37498751
• Pubmed Central ID:
  PMC10694996
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  164
• Issue:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:3b86478ab263dd9bf7eadbded3dd6272c08ea10ccae7475d8c76becc67397c9ed44402dc97f3ca69224f0869e6f067630a109ef4ecfb3fff7854cc8c235460c9
• Download URL:
  https://stacks.cdc.gov/view/cdc/136223/cdc_136223_DS1.pdf
• File Type:
  [PDF - 1.05 MB ]