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Observational Study
. 2019 Dec;23(12):3340-3349.
doi: 10.1007/s10461-019-02608-3.

Patterns and Correlates of Prescription Opioid Receipt Among US Veterans: A National, 18-Year Observational Cohort Study

Christopher T Rentsch  1   2 , E Jennifer Edelman  3   4 , Amy C Justice  5   3   4 , Brandon D L Marshall  6 , Ke Xu  7 , Andrew H Smith  7 , Stephen Crystal  8 , Julie R Gaither  9   10 , Adam J Gordon  11 , Rachel V Smith  12 , Rachel L Kember  13   14 , Renato Polimanti  7 , Joel Gelernter  7   15 , David A Fiellin  3   4 , Janet P Tate  5   3 , Henry R Kranzler  14   16 , William C Becker  3   10 ; VACS Project Team
Affiliations
Observational Study

Patterns and Correlates of Prescription Opioid Receipt Among US Veterans: A National, 18-Year Observational Cohort Study

Christopher T Rentsch et al. AIDS Behav. 2019 Dec.

Abstract

A better understanding of predisposition to transition to high-dose, long-term opioid therapy after initial opioid receipt could facilitate efforts to prevent opioid use disorder (OUD). We extracted data on 69,268 patients in the Veterans Aging Cohort Study who received any opioid prescription between 1998 and 2015. Using latent growth mixture modelling, we identified four distinguishable dose trajectories: low (53%), moderate (29%), escalating (13%), and rapidly escalating (5%). Compared to low dose trajectory, those in the rapidly escalating dose trajectory were proportionately more European-American (59% rapidly escalating vs. 38% low); had a higher prevalence of HIV (31% vs. 29%) and hepatitis C (18% vs. 12%); and during follow-up, had a higher incidence of OUD diagnoses (13% vs. 3%); were hospitalised more often [18.1/100 person-years (PYs) vs. 12.5/100 PY]; and had higher all-cause mortality (4.7/100 PY vs. 1.8/100 PY, all p < 0.0001). These measures can potentially be used in future prevention research, including genetic discovery.

Keywords: Electronic health records; Opioids; Pharmacoepidemiology; Pharmacy fill data; Phenotype.

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Conflict of interest statement

Conflict of Interest: Dr. Kranzler is a member of the American Society of Clinical Psychopharmacology’s Alcohol Clinical Trials Initiative, which was supported in the last 3 years by AbbVie, Alkermes, Ethypharm, Indivior, Lilly, Lundbeck, Otsuka, Pfizer, and XenoPort. Drs. Kranzler, Gelernter, and A. Smith are also named as inventors on PCT patent application #15/878,640 entitled: “Genotype-guided dosing of opioid agonists,” filed January 24, 2018. The remaining authors have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Study flow diagram Abbreviations: VACS - U.S. Veterans Aging Cohort Study; OUD - opioid use disorder; mg - milligrams; MEDD - morphine equivalent daily dose Note: ‘Evidence of OUD’ included OUD diagnoses, attendance at an opioid treatment programme, or receipt of buprenorphine
Figure 2.
Figure 2.
Prescription opioid dose trajectories among 69,268 opioid-exposed patients in the U.S. Veterans Aging Cohort Study, 1998–2015 Abbreviations: MEDD - morphine equivalent daily dose; mg - milligrams Note: major classes (i.e., unobserved latent sub-groups) of opioid dose trajectories were identified using latent growth mixture modelling
Figure 3.
Figure 3.
Substance use and NRS pain scores during follow-up by opioid dose trajectory, n=69,268 Abbreviations: NRS - numeric rating scale; OUD - opioid use disorder; AUD - alcohol use disorder Note: all chi-square tests p<0.0001
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