Association between opioid analgesic therapy and initiation of buprenorphine management: An analysis of prescription drug monitoring program data

English version

Autoři: Apostolos A. Alexandridis ^aff001; Nabarun Dasgupta ^aff001; Christopher L. Ringwalt ^aff001; Wayne D. Rosamond ^aff002; Paul R. Chelminski ^aff003; Stephen W. Marshall ^aff001
Působiště autorů: Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America ^aff001; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America ^aff002; Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America ^aff003
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0227350

Souhrn

Background

In the US, medication assisted treatment, particularly with office-based buprenorphine, has been an important component of opioid dependence treatment among patients with iatrogenic addiction to opioid analgesics. The predictors of initiating buprenorphine for addiction among opioid analgesic patients have not been well-described.

Methods

We conducted a time-to-event analysis using data from the North Carolina (NC) Prescription Drug Monitoring Program (PDMP). Our outcome of interest was time-to-initiation of sublingual buprenorphine. Our study population was a prospective cohort of all state residents receiving a full-agonist opioid analgesic between 2011 and 2015. Predictors of initiation of sublingual buprenorphine examined included: age, gender, cumulative pharmacies and prescribers utilized, cumulative opioid intensity (defined as cumulative opioid exposure divided by duration of opioid exposure), and benzodiazepine dispensing.

Findings

Of 4.3 million patients receiving opioid analgesics in NC between 2011 and 2015 (accumulated 8.30 million person-years of follow-up), and a total of 28,904 patients initiated buprenorphine formulations intended for addiction treatment (overall rate 3.48 per 1,000 person-years). In adjusted multivariate models, the utilization of 3 or more pharmacies (HR: 2.93; 95% CI: 2.82, 3.05) or 6 or more controlled substance prescribers (HR: 12.09; 95% CI: 10.76, 13.57) was associated with buprenorphine initiation. A dose-response relationship was observed for cumulative opioid intensity (HR in highest decile relative to lowest decile: 5.05; 95% CI: 4.70, 5.42). Benzodiazepine dispensing was negatively associated with buprenorphine initiation (HR: 0.63; 95% CI: 0.61, 0.65).

Conclusions

Opioid analgesic patients utilizing multiple prescribers or pharmacies are more likely to initiate sublingual buprenorphine. This finding suggests that patients with multiple healthcare interactions are more likely to be treated for high-risk opioid use, or may be more likely to be identified and treated for addiction. Future research should utilize prescription monitoring program data linked to electronic health records to include diagnosis information in analytic models.

Klíčová slova:

Physicians – Drug therapy – Outpatients – Addiction – Analgesics – Opioids – Pain management – Hydrocodone

Zdroje

1. Beauchamp GA, Winstanley EL, Ryan SA, Lyons MS. Moving Beyond Misuse and Diversion: The Urgent Need to Consider the Role of Iatrogenic Addiction in the Current Opioid Epidemic. American journal of public health. 2014;104(11):2023–9. doi: 10.2105/AJPH.2014.302147 25211712.

2. Noble M, Treadwell JR, Tregear SJ, Coates VH, Wiffen PJ, Akafomo C, et al. Long-term opioid management for chronic noncancer pain. Cochrane Database of Systematic Reviews. 2010;(1). doi: 10.1002/14651858.CD006605.pub2 CD006605. 20091598

3. Daum AM, Berkowitz O, Renner JA Jr. The evolution of chronic opioid therapy and recognizing addiction. Journal of the American Academy of Physician Assistants. 2015;28(5):23–7. doi: 10.1097/01.JAA.0000464268.60257.ad 25853674

4. Plunkett A, Kuehn D, Lenart M, Wilkinson I. Opioid maintenance, weaning and detoxification techniques: where we have been, where we are now and what the future holds. Pain management. 2013;3(4):277–84. doi: 10.2217/pmt.13.24 24654813.

5. Rosen K, Gutierrez A, Haller D, Potter JS. Sublingual Buprenorphine for Chronic Pain: A Survey of Clinician Prescribing Practices. The Clinical Journal of Pain. 2014;30(4):295–300. doi: 10.1097/AJP.0b013e318298ddad 00002508-201404000-00003. 23727654

6. James JR, Gordon LM, Klein JW, Merrill JO, Tsui JI. Interest in prescribing buprenorphine among resident and attending physicians at an urban teaching clinic. Substance abuse. 2018:1–3. doi: 10.1080/08897077.2018.1449176 29578857

7. Haffajee RL, Bohnert ASB, Lagisetty PA. Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment. American Journal of Preventive Medicine. 2018;54(6, Supplement 3):S230–S42. https://doi.org/10.1016/j.amepre.2017.12.022.

8. Andrilla CHA, Coulthard C, Patterson DG. Prescribing Practices of Rural Physicians Waivered to Prescribe Buprenorphine. American Journal of Preventive Medicine. 2018;54(6, Supplement 3):S208–S14. https://doi.org/10.1016/j.amepre.2018.02.006.

9. Knudsen HK. The Supply of Physicians Waivered to Prescribe Buprenorphine for Opioid Use Disorders in the United States: A State-Level Analysis. J Stud Alcohol Drugs. 2015;76(4):644–54. Epub 2015/06/23. doi: 10.15288/jsad.2015.76.644 26098042; PubMed Central PMCID: PMC4495082.

10. Dick AW, Pacula RL, Gordon AJ, Sorbero M, Burns RM, Leslie D, et al. Growth In Buprenorphine Waivers For Physicians Increased Potential Access To Opioid Agonist Treatment, 2002–11. Health Affairs. 2015;34(6):1028–34. doi: 10.1377/hlthaff.2014.1205 26056209

11. Rosenblatt RA, Andrilla CHA, Catlin M, Larson EH. Geographic and Specialty Distribution of US Physicians Trained to Treat Opioid Use Disorder. The Annals of Family Medicine. 2015;13(1):23–6. doi: 10.1370/afm.1735 25583888

12. Emmanuelli J, Desenclos JC. Harm reduction interventions, behaviours and associated health outcomes in France, 1996–2003. Addiction. 2005;100(11):1690–700. doi: 10.1111/j.1360-0443.2005.01271.x 16277629.

13. Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. The cochrane library. 2014.

14. Kraus ML, Alford DP, Kotz MM, Levounis P, Mandell TW, Meyer M, et al. Statement of the American Society Of Addiction Medicine Consensus Panel on the use of buprenorphine in office-based treatment of opioid addiction. J Addict Med. 2011;5(4):254–63. Epub 2011/11/02. doi: 10.1097/ADM.0b013e3182312983 22042215.

15. Amato L, Minozzi S, Davoli M, Vecchi S. Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Cochrane Database of Systematic Reviews. 2011;(10). doi: 10.1002/14651858.CD004147.pub4 CD004147. 21975742

16. Carroll KM, Weiss RD. The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment: A Review. American Journal of Psychiatry. 2017;174(8):738–47. doi: 10.1176/appi.ajp.2016.16070792 27978771.

17. National Academies of Sciences, Engineering, Medicine. Medications for Opioid Use Disorder Save Lives. Leshner AI, Mancher M, editors. Washington, DC: The National Academies Press; 2019. 180 p.

18. Frank D. “I Was Not Sick and I Didn't Need to Recover”: Methadone Maintenance Treatment (MMT) as a Refuge from Criminalization. Substance Use & Misuse. 2018;53(2):311–22. doi: 10.1080/10826084.2017.1310247 28704148

19. Thomas CP, Doyle E, Kreiner PW, Jones CM, Dubenitz J, Horan A, et al. Prescribing patterns of buprenorphine waivered physicians. Drug and alcohol dependence. 2017;181:213–8. doi: 10.1016/j.drugalcdep.2017.10.002 29096292

20. Zhu Y, Coyle DT, Mohamoud M, Zhou E, Eworuke E, Dormitzer C, et al. Concomitant use of buprenorphine for medication-assisted treatment of opioid use disorder and benzodiazepines: Using the prescription behavior surveillance system. Drug and alcohol dependence. 2018;187:221–6. doi: 10.1016/j.drugalcdep.2018.02.019 29680678

21. Alexandridis AA, McCort A, Ringwalt CL, Sachdeva N, Sanford C, Marshall SW, et al. A statewide evaluation of seven strategies to reduce opioid overdose in North Carolina. Injury Prevention. 2018;24:48–54. doi: 10.1136/injuryprev-2017-042396 28835443

22. Dasgupta N, Funk MJ, Proescholdbell S, Hirsch A, Ribisl KM, Marshall S. Cohort Study of the Impact of High-Dose Opioid Analgesics on Overdose Mortality. Pain Med. 2016;17(1):85–98. doi: 10.1111/pme.12907 26333030.

23. Centers for Disease Control and Prevention, U. S. Department of Health and Human Services. Calculating total daily dose of opioids for safer dosage. Available from: https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf.

24. Centers for Disease Control and Prevention. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65.

25. Coyle DT, Pratt CY, Ocran‐Appiah J, Secora A, Kornegay C, Staffa J. Opioid analgesic dose and the risk of misuse, overdose, and death: A narrative review. Pharmacoepidemiology and Drug Safety. 2018;27(5):464–72. doi: 10.1002/pds.4366 29243305

26. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. MMWR Recomm Rep. 2016;65(1):1–49. doi: 10.15585/mmwr.rr6501e1 26987082.

27. Lipari RN, Hughes A. How people obtain the prescription pain relievers they misuse. CBHSQ report. 2017;(Jan 12):1–7.

28. Lewis ET, Cucciare MA, Trafton JA. What do patients do with unused opioid medications? Clin J Pain. 2014;30(8):654–62. Epub 2013/11/28. doi: 10.1097/01.ajp.0000435447.96642.f4 24281287.

29. Wakeland W, Nielsen A, Geissert P. Dynamic model of nonmedical opioid use trajectories and potential policy interventions. The American Journal of Drug and Alcohol Abuse. 2015;41(6):508–18. doi: 10.3109/00952990.2015.1043435 25982491

30. Ciccarone D. The triple wave epidemic: Supply and demand drivers of the US opioid overdose crisis. Int J Drug Policy. 2019. doi: 10.1016/j.drugpo.2019.01.010 30718120.

31. Kansagra SM, Cohen MK. The Opioid Epidemic in NC: Progress, Challenges, and Opportunities. North Carolina Medical Journal. 2018;79(3):157–62. doi: 10.18043/ncm.79.3.157 29735617

32. McLean K, Kavanaugh PR. “They're making it so hard for people to get help:” Motivations for non-prescribed buprenorphine use in a time of treatment expansion. International Journal of Drug Policy. 2019;71:118–24. doi: 10.1016/j.drugpo.2019.06.019 31330267