Dose and Duration of Opioid Use in Propensity Score-Matched, Privately Insured Opioid Users With and Without Spinal Cord Injury

Brittany N Hand, James S Krause, Kit N Simpson
Archives of Physical Medicine and Rehabilitation 2018, 99 (5): 855-861

OBJECTIVES: 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.

DESIGN: Quasi-experimental analysis of archival data.

SETTING: Data used for the analysis were derived from Thompson Reuters MarketScan Commercial Claims and Encounters Databases for the years 2012 to 2013.

PARTICIPANTS: Participants (N=2908; aged 18-64y) included opioid users with SCI (n=1454) and propensity score-matched opioid users without SCI (n=1454). The cohorts were matched using demographics including comorbidities, hospital admissions, age, sex, and geographic region.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Medical and pharmacy claims from 2012 to 2013 MarketScan data were analyzed to characterize whether persons were short-term (<90d) or long-term (≥90d) opioid users, and whether persons had high (≥120mg) or low (<120mg) average daily morphine equivalents.

RESULTS: Persons with SCI were significantly more likely to be long-term users of low-dose, short-acting opioids (P<.0001) and more likely to be taking high morphine-equivalent doses of long-acting opioids (P<.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.

CONCLUSIONS: Persons with SCI are prescribed opioids for longer durations and at higher morphine-equivalent doses than controls, which may increase the 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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