Development of a potential opioid misuse measure from administrative dispensing data and contrasting opioid misuse among individuals on long-term tramadol, long-term short-acting hydrocodone or long-term short-acting oxycodone therapy in Arkansas

Abstract

Objective

This study sought to: (1) construct and validate a composite potential opioid misuse score; and (2) compare potential opioid misuse among individuals prescribed long-term therapy on tramadol, short-acting hydrocodone or short-acting oxycodone.

Methods

A retrospective cohort study was conducted using Arkansas All-Payer Claims Database (APCD; 2013–2018) linked to Arkansas Prescription Drug Monitoring Program (PDMP; 2014–2017) and state death certificate data (2013–2018). The study subjects were ambulatory, cancer-free adults with incident long-term therapy on tramadol, short-acting hydrocodone or short-acting oxycodone. The number of opioid prescribers/pharmacies, cash payment for opioid prescriptions, overlapping prescribers/pharmacies and a composite misuse score (derived from opioid prescribers/pharmacies and cash payment) were assessed in two 180 day windows as potential measures of misuse. The composite score was developed based on associations observed with opioid overdose and opioid-related injuries.

Results

A total of 17,816 (tramadol), 23,660 (hydrocodone) and 4799 (oxycodone) persons were included. The composite score had modest discrimination for overdose (c-index = 0.65). In the first 180 day period, the average composite misuse scores were 1.28 (tramadol), 1.93 (hydrocodone) and 2.18 (oxycodone). Compared to long-term hydrocodone, long-term tramadol had lower misuse (IRR [95% CI]: 0.75 [0.73–0.76]), and long-term oxycodone had higher misuse (1.09 [1.07–1.11]) in adjusted analyses. Qualitatively similar associations were observed for nearly all individual component measures of misuse.

Conclusion

A composite measure of potential opioid misuse had modest levels of discrimination in detecting overdose. In comparison to long-term hydrocodone therapy, long-term oxycodone had higher and tramadol had lower risk of potential opioid misuse.

Keywords:

• Tramadol
• hydrocodone
• oxycodone
• long-term opioid therapy
• opioid misuse

Transparency

Declaration of funding

Arkansas All-Payer Claims Database (APCD) was accessed through Arkansas Biosciences Institute. The Translational Research Institute (TRI) grant [UL1 TR003107] through the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) supported a prior study that linked the Arkansas APCD and Arkansas Prescription Drug Monitoring Program (PDMP) databases. The content of this study is solely the responsibility of the authors and does not represent the official views of the NIH.

Declaration of financial/other relationships

B.C.M. has disclosed that he has received royalties from TrestleTree LLC for the commercialization of an opioid risk prediction tool, which is unrelated to this investigation. No other potential conflict of interest was reported by the authors. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Study conception and design: all authors; data analysis: M.A.; interpretation of findings: all authors; writing initial draft: M.A. and B.C.M.; writing critical revision: all authors; supervision: B.C.M.; final approval: all authors.

Acknowledgements

The authors would like to thank the Arkansas Biosciences Institute for furnishing access to the Arkansas All Payers Claims Database.