Risks for Opioid Use and Abuse in Contrasting Chronic Pain Populations

Summary

Principal Investigator: M D Sullivan
Abstract: DESCRIPTION (provided by applicant): We hypothesize that increasing use of prescribed opioids for chronic pain in vulnerable patients with mental health disorders is the primary reason for escalating problems with opioid abuse and other negative health consequences of opioid use. This study will analyze 2002-2007 claims data from two complementary sources: 1] Highmark-Blue Shield private insurance plan (N= 3.5 million), 2] Arkansas Medicaid (N=660,000) We will study those individuals with the three most common chronic non-cancer pain conditions: back pain, joint pain, and headaches. In 2002, over 700,000 individuals from Highmark and over 100,000 individuals from Medicaid had a visit for one of these pain conditions. In 2002, 4.9% (n=34,819) of this Highmark chronic pain group and 12% (n=12,263) of this Medicaid chronic pain group were prescribed chronic opioids (>60 days/year), offering us over 250,000 person-years of observation of patients with chronic pain on chronic opioids . These datasets describe two groups who have geographical and demographic differences that are likely associated with different patterns of opioid use and different risks for opioid abuse. Specific Aims 1) Prevalence/Trends: To determine prevalence rates of chronic prescription opioid use (>60 days/year) for patients with back pain, arthritis/joint pain, and headaches during 2002-2006 and test for trends over time 2) Initiation: To identify persons with new treatment episodes for these chronic pain conditions, and follow them over time, using Cox proportional hazards models to assess predictors of chronic opioid initiation. 3) Discontinuation: Among all current chronic opioid users, to use Cox proportional hazards models to investigate the predictors of opioid discontinuation . 4) Opioid Abuse/Misuse: Among those who have ever been chronic opioid users, to use logistic and Poisson regression models to investigate predictors of: (a) Onset of diagnosed opioid abuse or dependence, (b) Onset of diagnosed non-opioid substance abuse or dependence, (c) Opioid behaviors suggestive of misuse (multiple pharmacies or prescribers, >365 days opioid supply/yr), (d) Negative health outcomes of opioid use: deaths, hospitalizations, ER visits, overdoses, injuries. 5) Substance Abuse: Among all patients with back pain, arthritis/joint pain, and headaches during 2002- 2006, to use logistic and Poisson regression models to investigate the effect of chronic opioid use on developing: (a) Onset of diagnosed opioid abuse or dependence, (b) Onset of diagnosed non-opioid substance abuse or dependence 6) Risk Stratification: Models derived from 2002-2006 data will be used to formulate risk stratification procedures concerning opioid use which will be validated in the final year (2007) of the study.
Funding Period: 2006-09-30 - 2010-04-30
more information: NIH RePORT

Top Publications

  1. pmc Effects of pain and prescription opioid use on outcomes in a collaborative care intervention for anxiety
    Peter Roy-Byrne
    Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98104, USA
    Clin J Pain 29:800-6. 2013
  2. pmc Mental health disorders and long-term opioid use among adolescents and young adults with chronic pain
    Laura P Richardson
    Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
    J Adolesc Health 50:553-8. 2012
  3. pmc Long-term chronic opioid therapy discontinuation rates from the TROUP study
    Bradley C Martin
    College of Pharmacy, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
    J Gen Intern Med 26:1450-7. 2011
  4. pmc Trends in the prescription of opioids for adolescents with non-cancer pain
    Laura P Richardson
    Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA
    Gen Hosp Psychiatry 33:423-8. 2011
  5. pmc Emergency department visits among recipients of chronic opioid therapy
    Jennifer Brennan Braden
    Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
    Arch Intern Med 170:1425-32. 2010
  6. pmc Risks for opioid abuse and dependence among recipients of chronic opioid therapy: results from the TROUP study
    Mark J Edlund
    Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
    Drug Alcohol Depend 112:90-8. 2010
  7. pmc An analysis of heavy utilizers of opioids for chronic noncancer pain in the TROUP study
    Mark J Edlund
    Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
    J Pain Symptom Manage 40:279-89. 2010
  8. pmc Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and medicaid insurance plans: The TROUP Study
    Mark D Sullivan
    Department of Psychiatry and Behavioral Sciences, Division of Consultation Liaison Psychiatry, University of Washington, Seattle, WA 98195 6560, USA
    Pain 150:332-9. 2010
  9. pmc Age and sex trends in long-term opioid use in two large American health systems between 2000 and 2005
    Stephen M Thielke
    University of Washington, Psychiatry and Behavioral Sciences, Seattle, Washington 98195, USA
    Pain Med 11:248-56. 2010
  10. pmc Trends in use of opioids for chronic noncancer pain among individuals with mental health and substance use disorders: the TROUP study
    Mark J Edlund
    Department of Psychiatry, Division of Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, USA
    Clin J Pain 26:1-8. 2010

Scientific Experts

Detail Information

Publications15

  1. pmc Effects of pain and prescription opioid use on outcomes in a collaborative care intervention for anxiety
    Peter Roy-Byrne
    Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98104, USA
    Clin J Pain 29:800-6. 2013
    ....
  2. pmc Mental health disorders and long-term opioid use among adolescents and young adults with chronic pain
    Laura P Richardson
    Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
    J Adolesc Health 50:553-8. 2012
    ....
  3. pmc Long-term chronic opioid therapy discontinuation rates from the TROUP study
    Bradley C Martin
    College of Pharmacy, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
    J Gen Intern Med 26:1450-7. 2011
    ..To report chronic opioid therapy discontinuation rates after five years and identify factors associated with discontinuation...
  4. pmc Trends in the prescription of opioids for adolescents with non-cancer pain
    Laura P Richardson
    Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA
    Gen Hosp Psychiatry 33:423-8. 2011
    ..The goal of the current study is to examine trends and factors associated with prescription opioid use among adolescents with common non-cancer pain (NCP) conditions, sampled from two contrasting populations...
  5. pmc Emergency department visits among recipients of chronic opioid therapy
    Jennifer Brennan Braden
    Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
    Arch Intern Med 170:1425-32. 2010
    ..There has been an increase in overdose deaths and emergency department visits (EDVs) involving use of prescription opioids, but the association between opioid prescribing and adverse outcomes is unclear...
  6. pmc Risks for opioid abuse and dependence among recipients of chronic opioid therapy: results from the TROUP study
    Mark J Edlund
    Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
    Drug Alcohol Depend 112:90-8. 2010
    ....
  7. pmc An analysis of heavy utilizers of opioids for chronic noncancer pain in the TROUP study
    Mark J Edlund
    Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
    J Pain Symptom Manage 40:279-89. 2010
    ..Although opioids are increasingly used for chronic noncancer pain (CNCP), we know little about opioid dosing patterns among individuals with CNCP in usual care settings, and how these are changing over time...
  8. pmc Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and medicaid insurance plans: The TROUP Study
    Mark D Sullivan
    Department of Psychiatry and Behavioral Sciences, Division of Consultation Liaison Psychiatry, University of Washington, Seattle, WA 98195 6560, USA
    Pain 150:332-9. 2010
    ..The consistency of the findings across diverse patient populations and the varying levels of misuse suggest that these results will generalize broadly, but await confirmation in other studies...
  9. pmc Age and sex trends in long-term opioid use in two large American health systems between 2000 and 2005
    Stephen M Thielke
    University of Washington, Psychiatry and Behavioral Sciences, Seattle, Washington 98195, USA
    Pain Med 11:248-56. 2010
    ..To estimate recent age- and sex-specific changes in long-term opioid prescription among patients with chronic pain in two large American Health Systems...
  10. pmc Trends in use of opioids for chronic noncancer pain among individuals with mental health and substance use disorders: the TROUP study
    Mark J Edlund
    Department of Psychiatry, Division of Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, USA
    Clin J Pain 26:1-8. 2010
    ..We analyzed trends between 2000 and 2005 in opioid prescribing among individuals with noncancer pain conditions (NCPC), with and without MH and SUDs...
  11. pmc Suicidal thoughts and behavior among adults with self-reported pain conditions in the national comorbidity survey replication
    Jennifer Brennan Braden
    Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195 6560, USA
    J Pain 9:1106-15. 2008
    ..1-1.8) and plan. Among pain subtypes, severe or frequent headaches and "other" chronic pain remained significantly associated with lifetime suicidal ideation and plan; "other" chronic pain was also associated with attempt...
  12. pmc Trends in use of opioids by noncancer pain type 2000-2005 among Arkansas Medicaid and HealthCore enrollees: results from the TROUP study
    Jennifer Brennan Braden
    Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195 6560, USA
    J Pain 9:1026-35. 2008
    ..The greatest increases in dose among all the pain conditions were seen in short-acting DEA Schedule II opioids...
  13. ncbi Epidemiology of regular prescribed opioid use: results from a national, population-based survey
    Teresa J Hudson
    Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas 72114, USA
    J Pain Symptom Manage 36:280-8. 2008
    ..The majority of regular users of opioids had multiple pain conditions (mean=1.9 pain conditions). Regular opioid users appear to have an overall lower level of health status and to have multiple, chronic physical health disorders...
  14. pmc Trends in use of opioids for non-cancer pain conditions 2000-2005 in commercial and Medicaid insurance plans: the TROUP study
    Mark D Sullivan
    Department of Psychiatry and Behavioral Sciences, Division of Consultation Liaison Psychiatry, University of Washington, Box 356560, 1959 NE Pacific Street, Seattle, WA 98195 6560, USA
    Pain 138:440-9. 2008
    ....