Dose and duration of opioid use in propensity score matched, privately insured opioid users with and without spinal cord injury

Publication date: Available online 4 January 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Brittany N. Hand, James S. Krause, Kit N. Simpson
ObjectiveThe objectives were to: 1) compare the opioid utilization patterns in opioid users with spinal cord injury (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.DesignQuasi-experimental analysis of archival dataSettingData used for the analysis were derived from Thompson Reuters MarketScan® Commercial Claims and Encounters Databases for the years 2012-2013.ParticipantsParticipants (aged 18-64 years) included 1,454 opioid users with SCI and 1,454 propensity score matched opioid users without SCI. The cohorts were matched using demographics including comorbidities, hospital admissions, age, gender, and geographic region.Interventionsn/aMain Outcome MeasuresMedical 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.ResultsResults 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 morphine equivalent doses of long-acting opioids (p<0.0001) 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.ConclusionPersons with SCI are prescribed opioids for longer durations of time and at higher morphine equivalent 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.



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