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. 2021 Jun;30(6):787-796.
doi: 10.1002/pds.5209. Epub 2021 Mar 16.

Chronic opioid use and complication risks in women with endometriosis: A cohort study in US administrative claims

Stephanie E Chiuve  1 , Ryan D Kilpatrick  1 , Mark D Hornstein  2 , Natalia Petruski-Ivleva  2 , Lani R Wegrzyn  1 , Elizabeth C Dabrowski  2 , Priscilla Velentgas  2 , Michael C Snabes  3 , Brian T Bateman  2
Affiliations

Chronic opioid use and complication risks in women with endometriosis: A cohort study in US administrative claims

Stephanie E Chiuve et al. Pharmacoepidemiol Drug Saf. 2021 Jun.

Abstract

Background: Women with endometriosis are prescribed opioids for pain relief but may be vulnerable to chronic opioid use given their comorbidity profile.

Methods: A cohort study was conducted in the Clinformatics™ DataMart database between 2006 and 2017 comparing women aged 18-50 years with endometriosis (N = 36 373) to those without (N = 2 172 936) in terms of risk of chronic opioid use, opioid dependence diagnosis, and opioid overdose. Chronic opioid use was defined as ≥120 days' supply dispensed or ≥10 fills of an opioid during any 365-day interval. Among women with endometriosis, we evaluated factors associated with higher risk of chronic opioid use and quantified the risk of complications associated with the use of opioids.

Results: Women with endometriosis were at greater risk for chronic opioid use (OR: 3.76; 95%CI: 3.57-3.96), dependence (OR: 2.73, 95%CI: 2.38-3.13) and overdose (OR: 4.34, 95%CI: 3.06-6.15) compared to women without. Chronic users displayed dose escalation and increase in days supplied over time, as well as co-prescribing with benzodiazepines and sedatives. Approximately 34% of chronic users developed constipation, 20% experienced falls, and 8% reported dizziness. Among endometriosis patients, women in younger age groups, those with other comorbidities associated with pain symptoms, as well as those with depression or anxiety were at a higher risk of developing chronic opioid use.

Conclusions: Women with endometriosis had a four times greater risk of chronic opioid use compared to women without. Multimorbidity among these patients was associated with the elevated risk of chronic opioid use and should be taken into account during treatment selection.

Keywords: chronic opioid use; chronic pain management; endometriosis-associated pain; healthcare utilization database; opioid utilization patterns.

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Conflict of interest statement

Stephanie E. Chiuve, Ryan D. Kilpatrick, Lani R. Wegrzyn, and Michael C. Snabes are employees of AbbVie receiving stock and/or stock options. Natalia Petruski‐Ivleva and Elizabeth C. Dabrowski, are employees of and holds stock at Aetion, Inc., a software and data analytics company that provides services to the healthcare industry. Priscilla Velentgas was an employee at Aetion at the time the work was completed and is currently an employee at IQVIA. Mark D. Hornstein and Brian T. Bateman conducted this work as paid consultants to Aetion, are publishing in that capacity. Mark D. Hornstein and Brian T. Bateman did not receive payment for authorship. Aetion received funding from AbbVie for conducting the study. These data were presented at the Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists, May 3–6, 2019, Nashville, TN.

Figures

FIGURE 1
FIGURE 1
Study design. a Excluded in evidence of the following baseline conditions: hysterectomy or oophorectomy. Chronic opioid use at baseline defined as >=30 days supply of an opioid dispensed in 6‐months baseline period. b Endometriosis was identified by either (1) ≥2 inpatient or outpatient claims with endometriosis‐related diagnoses codes (ICD‐9 codes 617.X or ICD‐10 codes N80.X), with the cohort entry date being the date of the second claim with endometriosis code; or (2) one inpatient or outpatient claim with an endometriosis code preceded by a laparoscopic procedure within the 30 days prior, with the cohort entry date being the date of the endometriosis claim. c Opioid use was defined as a dispensing of any of the following drugs: methadone, fentanyl, oxycodone, codeine, morphine, hydromorphone, oxymorphone, meperidine, opium, hydrocodone and tramadol. Chronic opioid use was defined as ≥120 days supply or ≥10 fills of an opioid during any 365‐day interval in the 2‐year follow‐up. Opioid dependence/abuse and opioid overdose were defined with ICD‐9 or ICD‐10 code [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Patient flow chart for study of chronic opioid use among women with endometriosis. Optum CDM data, 2006–2017. Two sets of study populations were used for the analysis. Cohort 1 (solid lines) was used in the analyses to quantify the trends in opioid initiation and chronic use and compare the 2‐year risk of chronic opioid use in women with endometriosis to the risk in women without endometriosis. Cohort 2 (dotted lines) includes women who have endometriosis only and was used in the analyses to characterize opioid use and dose trajectories in chronic compared to non‐chronic users, identify risk factors for chronic opioid use and quantify the association of chronic opioid use with its sequalae
FIGURE 3
FIGURE 3
Proportion of patients with at least one fill and dose trajectories over the two‐year period among chronic and non‐chronic users of opioids among endometriosis patients identified in Optum CDM. Mean total dose per period is calculated among those patients with at least one opioid fill during the period of interest. Follow‐up begins during the first fill. MME = Morphine Milligram Equivalents
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