Development and implementation of a prescription opioid registry across diverse health systems

G Thomas Ray¹, Andrea Altschuler¹, Ruchir Karmali^{1

2}, Ingrid Binswanger^{3

4

5}, Jason M Glanz^{3

6}, Christina L Clarke³, Brian Ahmedani⁷, Susan E Andrade⁸, Joseph A Boscarino⁹, Robin E Clark¹⁰, Irina V Haller¹¹, Rulin Hechter^{5

12}, Douglas W Roblin¹³, Katherine Sanchez¹⁴, Bobbi Jo Yarborough¹⁵, Steffani R Bailey¹⁶, Dennis McCarty^{17

18}, Kari A Stephens¹⁹, Carmen L Rosa²⁰, Andrea L Rubinstein²¹, Cynthia I Campbell^{1

5

22}

Affiliations

¹ Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
² Mathematica, Oakland, California, USA.
³ Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA.
⁴ Colorado Permanente Medical Group, Denver, Colorado, USA.
⁵ Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
⁶ Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA.
⁷ Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, Michigan, USA.
⁸ Meyers Primary Care Institute, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
⁹ Department of Population Health Sciences, Geisinger Clinic, Danville, Pennsylvania, USA.
¹⁰ Department of Family Medicine and Community Health, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts, USA.
¹¹ Essentia Institute of Rural Health, Duluth, Minnesota, USA.
¹² Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
¹³ Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, Maryland, USA.
¹⁴ Baylor Scott & White Research Institute, Dallas, Texas, and School of Social Work, University of Texas at Arlington, Arlington, Texas, USA.
¹⁵ Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA.
¹⁶ Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
¹⁷ OHSU-PSU School of Public Health, Portland, Oregon, USA.
¹⁸ Division of General and Internal Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
¹⁹ Department of Family Medicine, University of Washington, Seattle, Washington, USA.
²⁰ Center for the Clinicals Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA.
²¹ Department of Pain Medicine, The Permanente Medical Group, Santa Rosa, California, USA.
²² Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA.

PMID: 35651523
PMCID: PMC9150082
DOI: 10.1093/jamiaopen/ooac030

Development and implementation of a prescription opioid registry across diverse health systems

G Thomas Ray et al. JAMIA Open. 2022.

. 2022 May 17;5(2):ooac030.

doi: 10.1093/jamiaopen/ooac030. eCollection 2022 Jul.

Authors

Affiliations

¹ Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
² Mathematica, Oakland, California, USA.
³ Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA.
⁴ Colorado Permanente Medical Group, Denver, Colorado, USA.
⁵ Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
⁶ Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA.
⁷ Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, Michigan, USA.
⁸ Meyers Primary Care Institute, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
⁹ Department of Population Health Sciences, Geisinger Clinic, Danville, Pennsylvania, USA.
¹⁰ Department of Family Medicine and Community Health, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts, USA.
¹¹ Essentia Institute of Rural Health, Duluth, Minnesota, USA.
¹² Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
¹³ Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, Maryland, USA.
¹⁴ Baylor Scott & White Research Institute, Dallas, Texas, and School of Social Work, University of Texas at Arlington, Arlington, Texas, USA.
¹⁵ Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA.
¹⁶ Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
¹⁷ OHSU-PSU School of Public Health, Portland, Oregon, USA.
¹⁸ Division of General and Internal Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
¹⁹ Department of Family Medicine, University of Washington, Seattle, Washington, USA.
²⁰ Center for the Clinicals Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA.
²¹ Department of Pain Medicine, The Permanente Medical Group, Santa Rosa, California, USA.
²² Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA.

PMID: 35651523
PMCID: PMC9150082
DOI: 10.1093/jamiaopen/ooac030

Abstract

Objective: Develop and implement a prescription opioid registry in 10 diverse health systems across the US and describe trends in prescribed opioids between 2012 and 2018.

Materials and methods: Using electronic health record and claims data, we identified patients who had an outpatient fill for any prescription opioid, and/or an opioid use disorder diagnosis, between January 1, 2012 and December 31, 2018. The registry contains distributed files of prescription opioids, benzodiazepines and other select medications, opioid antagonists, clinical diagnoses, procedures, health services utilization, and health plan membership. Rates of outpatient opioid fills over the study period, standardized to health system demographic distributions, are described by age, gender, and race/ethnicity among members without cancer.

Results: The registry includes 6 249 710 patients and over 40 million outpatient opioid fills. For the combined registry population, opioid fills declined from a high of 0.718 per member-year in 2013 to 0.478 in 2018, and morphine milligram equivalents (MMEs) per fill declined from 985 MMEs per fill in 2012 to 758 MMEs in 2018. MMEs per member declined from 692 MMEs per member in 2012 to 362 MMEs per member in 2018.

Conclusion: This study established a population-based opioid registry across 10 diverse health systems that can be used to address questions related to opioid use. Initial analyses showed large reductions in overall opioid use per member among the combined health systems. The registry will be used in future studies to answer a broad range of other critical public health issues relating to prescription opioid use.

Keywords: EHR data; opioid use disorder; prescription opioids; registry.

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Figures

**Figure 1.**
Opioid registry entity relationship diagram with selected variables shown.

**Figure 2.**
Outpatient opioid fills and morphine milligram equivalents per member-month by month, all opioid registry sites combined, 2012–2018.

**Figure 3.**
Outpatient morphine milligram equivalents filled per member-month by gender and month, all opioid registry sites combined, 2012–2018.

**Figure 4.**
Outpatient morphine milligram equivalents filled per member-month by age group and month, all opioid registry sites combined, 2012–2018.

**Figure 5.**
Outpatient morphine milligram equivalents filled per member-month by race/ethnicity and month, all opioid registry sites combined, 2012–2018.

See this image and copyright information in PMC

References

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Development and implementation of a prescription opioid registry across diverse health systems

Affiliations

Development and implementation of a prescription opioid registry across diverse health systems

Authors

Affiliations

Abstract

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources