Opioid Prescribing and Health Outcomes in Opioid Naive Patients in Indiana: Analysis of a Statewide Health Information Exchange Database

BackgroundWidespread use of prescription opioids has been a major public health concern since 1999. Many consequences are associated with the problem, such as opioid misuse, abuse, and drug overdose deaths. Opioids are not the only medications involved with drug overdose deaths. Due to stricter control of prescription opioids, those who misused opioids are associated with initiation of another illicit drug abuse. This results in increased drug overdose death involving heroin and semisynthetic/synthetic opioids. Another risk factor for increased overdose death is concurrent use of opioids with other central nervous system (CNS) depressants and some anticonvulsants. Concurrent use of opioids and benzodiazepine, z-drugs (zolpidem and zaleplon), gabapentin, and/or pregabalin is associated with increased risk of respiratory depression and drug overdose death. To combat problematic opioid use, many mitigation strategies were introduced. However, opioid-related problems remain. Widespread use of prescription opioids has been a major public health concern since 1999. Many consequences are associated with the problem, such as opioid misuse, abuse, and drug overdose deaths. Opioids are not the only medications involved with drug overdose deaths. Due to stricter control of prescription opioids, those who misused opioids are associated with initiation of another illicit drug abuse. This results in increased drug overdose death involving heroin and semisynthetic/synthetic opioids. Another risk factor for increased overdose death is concurrent use of opioids with other central nervous system (CNS) depressants and some anticonvulsants. Concurrent use of opioids and benzodiazepine, z-drugs (zolpidem and zaleplon), gabapentin, and/or pregabalin is associated with increased risk of respiratory depression and drug overdose death. To combat problematic opioid use, many mitigation strategies were introduced. However, opioid-related problems remain. ObjectiveTo inform efforts that improve opioid prescribing for noncancer pain and health outcomes of patients receiving opioids in Indiana. MethodsThis is a retrospective cohort of patients whose data were contained within the Indiana Network for Patient Care (INPC). INPC was a statewide health information exchange database that captured and stored clinical data from Indiana’s health systems including hospitals, health networks, and insurance providers. Data from the INPC used in this study included patient, pharmacy, and encounter data. The study period spanned from January 2012 to December 2017. The inclusion criteria included opioid naive adult patients who were at least 18 years old. Patients had to have at least one opioid prescription within the study period which was defined as index date. Opioid naive was defined as having no history of opioid prescription in the previous year. Patients must have at least six months of available data after index date. Patients with cancer, terminal illness, and those received hospice care were excluded. Dependent variables included a composite outcome of opioid abuse, dependence, and overdose identified by ICD-9 or ICD-10 codes, all-cause mortality, number of all-cause hospitalizations, and number of all-cause emergency department visits (ED). Independent variables included age, sex, race, Charlson Comorbidity Index (CCI), mental health conditions, long-term opioid use, opioid dose, opioid days supply, use of medication-assisted therapy, benzodiazepine dose, benzodiazepine days supply, and concurrent use of opioids and benzodiazepines and/or gabapentin/pregabalin within 30 days