Prescription opioid characteristics at initiation for non-cancer pain and risk of treated opioid use disorder: A population-based study. (1st April 2021)

• Record Type: Journal Article
• Authors: Papadomanolakis-Pakis, Nicholas; Moore, Kieran M.; Peng, Yingwei; Gomes, Tara
• Is Part Of: Drug and alcohol dependence. Volume 221(2021)
• Publication Date: 2021-04-01
• Subjects: Addiction -- Opioid analgesics -- Opioids -- Opioid use disorder -- Non-cancer pain -- Pharmacoepidemiology; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2021.108601
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Incidence of opioid use disorder (OUD) is difficult to measure at population level. Incidence of treated OUD varies by dose and pain indication at initiation. Risk of treated OUD differs based on modifiable prescription factors. Higher average daily doses are associated with greater risk of treated OUD. Long-acting opioids, days' supply ≥11, associated with greater risk of treated OUD. Abstract: Background: Long-term prescription opioid use has been associated with adverse health outcomes, including opioid use disorder (OUD). We examined a population of opioid naïve individuals who initiated prescription opioids for non-cancer pain and investigated the associations between opioid prescription characteristics at initiation and time to treated OUD. Methods: We conducted a retrospective population-based cohort study in Ontario, Canada among opioid naïve individuals aged 15 years and older dispensed an opioid for non-cancer pain between 2013 and 2016. We used the Narcotic Monitoring System to abstract opioid dispensing data. A multivariable Cox regression model was used to examine the association between average daily dose and time to treated OUD. Results: We identified 1, 607, 659 opioid-naïve individuals who initiated a prescription opioid within the study period. The incidence of treated OUD within the study period was 86 cases per 100, 000 person-years. Compared to an average daily dose of <20 morphine milligrams equivalent (MME), higher average daily doses at initiation were associated with greater hazard of treated OUD, 20–50 MME (HR 1.11, 95% CI: 1.02, 1.21), >50−90 MME (HR 1.29, 95% CI: 1.16, 1.44), >90−150 MME (HR 1.29, 95% CI: 1.06, 1.56), >150–200 MME (HR 2.49, 95% CI: 1.54, 4.03) and >200 MME (HR 4.15, 95% CI: 2.89, 5.97). Long-acting formulations and days' supply ≥11 days were also associated with greater hazard of treated OUD. Conclusion: Prescription opioid characteristics at initiation are associated with risk of treated OUD, identifying potentially important and modifiable risk factors among people initiating opioids for non-cancer pain.