Defining Non-Medical Use Of Prescription Opioids within Health Care Claims: A Systematic Review

Details

• Alternative Title:
  Subst Abus
• Personal Author:
  Cochran, Gerald ; Woo, Bongki ; Lo-Ciganic, Wei-Hsuan ; Gordon, Adam J. ; Donohue, Julie M. ; Gellad, Walid F.
• Description:
  Background
  
  Health insurance claims data may play an important role for healthcare systems and payers in monitoring the non-medical use of prescription opioids (NMPO) among patients. However, these systems require valid methods for identifying NMPO if they are to target individuals for intervention. Limited efforts have been made to define NMPO using administrative data available to health systems and payers. We conducted a systematic review of publications that defined and measured NMPO within health insurance claims databases in order to describe definitions of NMPO and identify areas for improvement.
  
  Methods
  
  We searched eight electronic databases for articles that included terms related to NMPO and health insurance claims. A total of 2,613 articles were identified in our search. Titles, abstracts, and article full texts were assessed according to predetermined inclusion/exclusion criteria. Following article selection, we extracted general information, conceptual and operational definitions of NMPO, methods used to validate operational definitions of NMPO, and rates of NMPO.
  
  Results
  
  A total of seven studies met all inclusion criteria. A range of conceptual NMPO definitions emerged, from concrete concepts of abuse to qualified definitions of probable misuse. Operational definitions also varied, ranging from variables that rely on diagnostic codes to those that rely on opioid dosage and/or filling patterns. Quantitative validation of NMPO definitions was reported in three studies (e.g., receiver operating curves or logistic regression), with each study indicating adequate validity. Three studies reported qualitative validation, using face and content validity. One study reported no validation efforts. Rates of NMPO among the studies’ populations ranged from 0.75–10.32%.
  
  Conclusions
  
  Disparate definitions of NMPO emerged from the literature, with little uniformity in conceptualization and operationalization. Validation approaches were also limited, and rates of NMPO varied across studies. Future research should prospectively test and validate a construct of NMPO to disseminate to payers and health officials.
  
  
• Subjects:
  Analgesics, Opioid Article Humans Insurance, Health Insurance Benefits Substance-Related Disorders Terminology As Topic
• Source:
  Subst Abus. 36(2):192-202
• Pubmed ID:
  25671499
• Pubmed Central ID:
  PMC4736503
• Document Type:
  Journal Article
• Funding:
  U01 CE002496/CE/NCIPC CDC HHS/United States ; U01CE002496-01/CE/NCIPC CDC HHS/United States
• Volume:
  36
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:4deb01c2c91d7a7abf4e0da48c51db0af51cc2fa26bb594cfc5f898de296fa09
• Download URL:
  https://stacks.cdc.gov/view/cdc/37853/cdc_37853_DS1.pdf
• File Type:
  [PDF - 283.18 KB ]