AN EXAMINATION OF CLAIMS-BASED PREDICTORS OF OVERDOSE FROM A LARGE MEDICAID PROGRAM

Details

• Alternative Title:
  Med Care
• Personal Author:
  Cochran, Gerald ; Gordon, Adam J. ; Lo-Ciganic, Wei-Hsuan ; Gellad, Walid F. ; Frazier, Winfred ; Lobo, Carroline ; Chang, Joyce ; Zheng, Ping ; Donohue, Julie M.
• Description:
  Background
  
  Health systems may play an important role in identification of patients at-risk of opioid medication overdose. However, standard measures for identifying overdose risk in administrative data do not exist.
  
  Objective
  
  Examine the association between opioid medication overdose and 2 validated measures of non-medical use of prescription opioids within claims data.
  
  Research Design
  
  A longitudinal retrospective cohort study that estimated associations between overdose and non-medical use.
  
  Subjects
  
  Adult Pennsylvania Medicaid program 2007-2012 patients initiating opioid treatment who were: non-dual eligible, without cancer diagnosis, and not in long-term care facilities or receiving hospice.
  
  Measures
  
  Overdose (International Classification of Disease, 9th edition, prescription opioid poisonings codes), opioid abuse (opioid use disorder diagnosis while possessing an opioid prescription), opioid misuse (a composite indicator of number of opioid prescribers, number of pharmacies, and days supplied), and dose exposure during opioid treatment episodes.
  
  Results
  
  A total of 372,347 Medicaid enrollees with 583,013 new opioid treatment episodes were included in the cohort. Opioid overdose was higher among those with abuse (1.5%) compared to those without (0.2%, p<0.001). Overdose was higher among those with probable (1.8%) and possible (0.9%) misuse compared to those without (0.2%, p<0.001). Abuse (adjusted rate ratio [ARR]=1.52, 95% CI=1.10-2.10), probable misuse (ARR=1.98, 95% CI=1.46-2.67), and possible misuse (ARR=1.76, 95% CI=1.48-2.09) were associated with significantly more events of opioid medication overdose compared to those without.
  
  Conclusions
  
  Claims-based measures can be employed by health systems to identify individuals at-risk of overdose who can be targeted for restrictions on opioid prescribing, dispensing, or referral to treatment.
  
  
• Subjects:
  Adolescent Adult Age Factors Analgesics, Opioid Comorbidity Drug Overdose Female Humans Insurance Claim Review Longitudinal Studies Male Medicaid Middle Aged Opioid-Related Disorders Pharmacies Practice Patterns, Physicians' Residence Characteristics Retrospective Studies Sex Factors Socioeconomic Factors Young Adult

  More +
• Source:
  Med Care. 55(3):291-298.
• Pubmed ID:
  27984346
• Pubmed Central ID:
  PMC5309160
• Document Type:
  Journal Article
• Funding:
  U01 CE002496/CE/NCIPC CDC HHS/United States
• Place as Subject:
  Pennsylvania ; United States
• Volume:
  55
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:6bcb1b410e46289120d45c26c893a9315ee51de13230d16857f321d66f54d945
• Download URL:
  https://stacks.cdc.gov/view/cdc/44208/cdc_44208_DS1.pdf
• File Type:
  [PDF - 1.19 MB ]