Opioid therapy trajectories of patients with chronic non-cancer pain over 1 year of follow-up after initiation of short-acting opioid formulations

Abstract

Objective: This study compared opioid utilization trajectories of persons initiating tramadol, short-acting hydrocodone, or short-acting oxycodone, and it characterized opioid dose trajectories and type of opioid in persistent opioid therapy subsamples.

Methods: A retrospective cohort study of adults with chronic non-cancer pain who were initiating opioid therapy was conducted with the IQVIA PharMetrics® Plus for Academics data (2008-2018). Continuous enrollment was required for 6 months before ("baseline") and 12 months after ("follow-up") the first opioid prescription ("index date"). Opioid therapy measures were assessed every 7 days over follow-up. Group-based trajectory modeling (GBTM) was used to identify trajectories for any opioid and total morphine milligram equivalent measures, and longitudinal latent class analysis was used for opioid therapy type.

Results: A total of 40 276 tramadol, 141 023 hydrocodone, and 45 221 oxycodone initiators were included. GBTM on any opioid therapy identified 3 latent trajectories: early discontinuers (tramadol 39.0%, hydrocodone 54.1%, oxycodone 61.4%), late discontinuers (tramadol 37.9%, hydrocodone 39.4%, oxycodone 33.3%), and persistent therapy (tramadol 6.7%, hydrocodone 6.5%, oxycodone 5.3%). An additional fourth trajectory, intermittent therapy (tramadol 16.4%), was identified for tramadol initiators. Of those on persistent therapy, 2687 individuals were on persistent therapy with tramadol, 9169 with hydrocodone, and 2377 with oxycodone. GBTM on opioid dose resulted in 6 similar trajectory groups in each persistent therapy group. Longitudinal latent class analysis on opioid therapy type identified 6 latent classes for tramadol and oxycodone and 7 classes for hydrocodone.

Conclusion: Opioid therapy patterns meaningfully differed by the initial opioid prescribed, notably the presence of intermittent therapy among tramadol initiators and higher morphine milligram equivalents and prescribing of long-acting opioids among oxycodone initiators.

Keywords: hydrocodone; latent class; oxycodone; trajectory analysis; tramadol.

Figure 1.

Study diagram. Dx= diagnosis.

Figure 2.

Inclusion and exclusion criteria and final sample selection.

Figure 3.

Latent trajectories based on group-based trajectory modeling of weekly opioid therapy of tramadol, short-acting hydrocodone, and short-acting oxycodone initiators.

Figure 4.

Latent trajectories identified from group-based trajectory modeling of opioid dose (morphine milligrams equivalent [MME]) in subsamples of persistent therapy among tramadol (n = 2687), short-acting hydrocodone (n = 9169), and short-acting oxycodone initiators (n = 2377).

Figure 5.

Latent trajectories of opioid type identified from longitudinal latent class analysis in individuals with persistent therapy who initiated opioid use on tramadol (n = 2687). sa= short-acting.

Figure 6.

Latent trajectories of opioid type identified from longitudinal latent class analysis in individuals with persistent therapy who initiated opioid use on hydrocodone (n = 9169). sa= short-acting.

Figure 7.

Latent trajectories of opioid type identified from longitudinal latent class analysis in individuals with persistent therapy who initiated opioid use on oxycodone (n = 2377). sa= short-acting.