Opioid utilization in persons with and without spinal cord injury: A propensity-score matched comparison of opioid users in a privately insured population
Hand B, Krause J, Simpson K
Medical University of South Carolina, Charleston, South caro, USA
Background: The rate of deaths from opioid overdose in the United States has increased by 200% since the year 2000 (1). As a result, the Centers for Disease Control and Prevention has declared opioid overdose an epidemic. Persons with spinal cord injury (SCI) may be particularly vulnerable to the risks associated with opioid use, as approximately 70% receive an opioid prescription (2). Pain medication use by persons with SCI increases risk of adverse drug-related events (3), falls (4), lower extremity fractures (5), mortality (6), and fatigue (7). Evidence from other populations suggests the risks associated with opioids are driven by the dose, duration of use, and type of opioid prescribed (i.e., short-acting or long-acting) (8,9). To date, however, little is known about trends in dose and duration of opioid use among opioid users with SCI. Objective: The present study sought to: 1) compare the opioid utilization patterns in opioid users with SCI to a propensity score matched general population of opioid users without SCI and 2) identify characteristics of persons with SCI associated with long-term and/or high-dose use of opioids. Methods: Data used for the analysis were derived from Thompson Reuters MarketScan(R) Commercial Claims and Encounters Databases for the years 2012-2013. Participants (aged 18-64 years) included 1,868 opioid users with SCI and 1,868 propensity score matched opioid users without SCI. The cohorts were matched using demographics including comorbidities, hospital admissions, age, gender, and geographic region. Medical and pharmacy claims from 2012-2013 MarketScan data were analyzed to characterize whether persons were short-term (<90 days) or long-term (90 days) opioid users and whether persons had high (120 mg) or low (<120 mg) average daily morphine equivalents (ME). Results: Results indicated persons with SCI were significantly more likely to be long-term users of low-dose short acting opioids (p<0.0001) and more likely to be on high ME doses of long acting opioids (p=0.002) than matched controls. Among persons with SCI, those with lumbar/sacral injuries had more days supply of high-dose long acting opioids than did persons with thoracic or cervical injuries. Conclusion: Persons with SCI are prescribed opioids for longer durations of time and at higher ME doses than controls, which may increase risk of opioid dependence or adverse drug events. Findings should be considered in the development of practice guidelines for alternate pain management options or opioid dependence interventions for persons with SCI. Support: This work was supported by the South Carolina Spinal Cord Injury Research Fund, grant number #2016 PD-01 and the South Carolina Clinical & Translational Research (SCTR) Institute, through NIH - NCATS Grant Number UL1 TR001450. Data analytic support for the study was provided through support for the CEDAR core funded by the MUSC Office of the Provost.
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