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  1. Article ; Online: Impact of overdose on health plan disenrollment among patients prescribed long-term opioids: Retrospective cohort study.

    Fenton, Joshua J / Magnan, Elizabeth M / Tancredi, Daniel J / Tseregounis, Iraklis Erik / Agnoli, Alicia L

    Drug and alcohol dependence

    2024  Volume 258, Page(s) 111277

    Abstract: Context: Health plan disenrollment may disrupt chronic or preventive care for patients prescribed long-term opioid therapy (LTOT).: Purpose: To assess whether overdose events in patients prescribed LTOT are associated with subsequent health plan ... ...

    Abstract Context: Health plan disenrollment may disrupt chronic or preventive care for patients prescribed long-term opioid therapy (LTOT).
    Purpose: To assess whether overdose events in patients prescribed LTOT are associated with subsequent health plan disenrollment.
    Design: Retrospective cohort study.
    Setting and dataset: Data from the Optum Labs Data Warehouse which includes de-identified medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees. The database contains longitudinal health information on patients, representing a mixture of ages and geographical regions across the United States.
    Patients: Adults prescribed stable opioid therapy (≥10 morphine milligram equivalents/day) for a 6-month baseline period prior to an index opioid prescription from January 1, 2018 to December 31, 2018.
    Main measures: Health plan disenrollment during follow-up.
    Results: The cohort comprised 404,151 patients who were followed up after 800,250 baseline periods of stable opioid dosing. During a mean follow-up of 9.1 months, unadjusted disenrollment rates among primary commercial beneficiaries and Medicare Advantage enrollees were 37.2 and 13.9 per 100 person-years, respectively. Incident overdoses were associated with subsequent health plan disenrollment with a statistically significantly stronger association among primary commercial insurance beneficiaries [adjusted incidence rate ratio (aIRR) 1.48 (95% CI: 1.33-1.64)] as compared to Medicare Advantage enrollees [aIRR 1.15 (95% CI: 1.07-1.23)].
    Conclusions: Among patients prescribed long-term opioids, overdose events were strongly associated with subsequent health plan disenrollment, especially among primary commercial insurance beneficiaries. These findings raise concerns about the social consequences of overdose, including potential health insurance loss, which may limit patient access to care at a time of heightened vulnerability.
    Language English
    Publishing date 2024-03-30
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 519918-9
    ISSN 1879-0046 ; 0376-8716
    ISSN (online) 1879-0046
    ISSN 0376-8716
    DOI 10.1016/j.drugalcdep.2024.111277
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1310: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  2. Article ; Online: Urine Drug Testing Among Patients Prescribed Long-Term Opioid Therapy: Patient and Clinician Factors.

    Agnoli, Alicia L / Howe, Rebecca / Magnan, Elizabeth / Jerant, Anthony / Colby, Daniel / Franks, Peter

    Journal of the American Board of Family Medicine : JABFM

    2023  Volume 36, Issue 4, Page(s) 537–541

    Abstract: Introduction: National guidelines recommend that patients with chronic noncancer pain prescribed long-term opioid therapy (LTOT) undergo periodic urine drug testing (UDT), yet UDT is performed inconsistently, and little evidence supports the utility of ... ...

    Abstract Introduction: National guidelines recommend that patients with chronic noncancer pain prescribed long-term opioid therapy (LTOT) undergo periodic urine drug testing (UDT), yet UDT is performed inconsistently, and little evidence supports the utility of this approach. We examined patient and prescriber factors associated with UDT.
    Methods: A 1-year retrospective cohort study of 5690 patients prescribed LTOT by 689 clinicians in a network of 13 primary care and specialty clinics. Negative binomial regression examined patient and prescriber factors associated with the number of tests completed, and logistic regression examined prescriber and practice level testing likelihood. Analyses were adjusted for patient and clinician characteristics and accounted for patient clustering within prescribers.
    Results: A total of 2256 patients (39.6%) had UDT completed at least once. More UDT completion was associated with Black patient race and receipt of more opioid prescriptions, as well as with clinician testing compliance.
    Conclusions: UDT was relatively infrequent in patients prescribed LTOT and associated with patient factors not known to confer greater opioid-related risk, such as race. In addition, there was significant clinician-driven variation in UDT. Given the uncertain clinical utility of such testing, these findings signal the need for strategies to address potential biases in the use of UDT.
    MeSH term(s) Humans ; Analgesics, Opioid/therapeutic use ; Analgesics, Opioid/urine ; Black People ; Chronic Pain/drug therapy ; Retrospective Studies ; Substance Abuse Detection/methods ; Drug Prescriptions
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2023-07-19
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural
    ZDB-ID 2239939-2
    ISSN 1558-7118 ; 1557-2625
    ISSN (online) 1558-7118
    ISSN 1557-2625
    DOI 10.3122/jabfm.2022.220360R1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 2626: Show issues Location:
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  3. Article ; Online: Long-term Risk of Overdose or Mental Health Crisis After Opioid Dose Tapering.

    Fenton, Joshua J / Magnan, Elizabeth / Tseregounis, Irakis Erik / Xing, Guibo / Agnoli, Alicia L / Tancredi, Daniel J

    JAMA network open

    2022  Volume 5, Issue 6, Page(s) e2216726

    Abstract: Importance: Patients prescribed long-term opioid therapy are increasingly undergoing dose tapering. Recent studies suggest that tapering is associated with short-term risks of substance misuse, overdose, and mental health crisis, although lower opioid ... ...

    Abstract Importance: Patients prescribed long-term opioid therapy are increasingly undergoing dose tapering. Recent studies suggest that tapering is associated with short-term risks of substance misuse, overdose, and mental health crisis, although lower opioid dose could reduce risks of adverse events over the longer term.
    Objective: To assess the longer-term risks of overdose or mental health crisis associated with opioid dose tapering.
    Design, setting, and participants: This is a cohort study using an exposure-crossover analysis. Data were obtained from the OptumLabs Data Warehouse, which includes deidentified medical and pharmacy claims and enrollment records for commercial insurance and Medicare Advantage enrollees, representing a diverse mixture of ages, races, ethnicities, and geographical regions across the US. Participants were US adults who underwent opioid dose tapering from 2008 to 2017 after a 12-month baseline period of stable daily dosing of 50 morphine milligram equivalents or higher and who had at least 1 month of long-term follow-up during a postinduction period beginning 12 months after taper initiation. Data analysis was performed from October 2021 to April 2022.
    Exposures: Opioid tapering, defined as 15% or more relative reduction in mean daily dose during any of 6 overlapping 60-day windows within a 7-month follow-up period after the stable baseline period.
    Main outcomes and measures: Emergency or hospital encounters for drug overdose or withdrawal and mental health crisis (depression, anxiety, or suicide attempt). Outcome counts were assessed in pretaper and postinduction periods (from 12 to 24 months after taper initiation).
    Results: The study included 21 515 tapering events among 19 377 patients with a mean (SD) of 9.1 (2.7) months of postinduction follow-up per event (median [IQR], 10 [8-11] months). Patients had a mean (SD) age of 56.9 (11.2) years, 11 581 (53.8%) were female, and 8217 (38.2%) had commercial insurance (vs Medicare Advantage). In conditional negative binomial regression analyses, adjusted incidence rate ratios for the postinduction period compared with the pretaper period were 1.57 (95% CI, 1.42-1.74) for overdose or withdrawal and 1.52 (95% CI, 1.35-1.71) for mental health crisis.
    Conclusions and relevance: These findings suggest that opioid tapering was associated with increased rates of overdose, withdrawal, and mental health crisis extending up to 2 years after taper initiation.
    MeSH term(s) Adult ; Aged ; Analgesics, Opioid/therapeutic use ; Cohort Studies ; Drug Overdose/etiology ; Drug Tapering ; Female ; Humans ; Male ; Medicare Part C ; Mental Health ; Middle Aged ; United States/epidemiology
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2022-06-01
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2022.16726
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  4. Article ; Online: Association of social isolation and loneliness with telehealth use among older adults during COVID-19.

    Howe, Rebecca J / Bell, Janice F / Bidwell, Julie T / Fenton, Joshua J / Amadi, Grace P / Agnoli, Alicia L

    Journal of the American Geriatrics Society

    2023  Volume 71, Issue 7, Page(s) 2334–2336

    MeSH term(s) Humans ; Aged ; Loneliness ; COVID-19 ; Social Isolation ; Telemedicine
    Language English
    Publishing date 2023-02-02
    Publishing country United States
    Document type Letter ; Research Support, N.I.H., Extramural
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.18270
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    Ud II Zs.168: Show issues Location:
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    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

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  5. Article ; Online: Longitudinal Dose Trajectory Among Patients Tapering Long-Term Opioids.

    Fenton, Joshua J / Magnan, Elizabeth M / Agnoli, Alicia L / Henry, Stephen G / Xing, Guibo / Tancredi, Daniel J

    Pain medicine (Malden, Mass.)

    2021  Volume 22, Issue 7, Page(s) 1660–1668

    Abstract: Objective: To evaluate the dose trajectory of new opioid tapers and estimate the percentage of patients with sustained tapers at long-term follow-up.: Design: Retrospective cohort study.: Setting: Data from the OptumLabs Data Warehouse® which ... ...

    Abstract Objective: To evaluate the dose trajectory of new opioid tapers and estimate the percentage of patients with sustained tapers at long-term follow-up.
    Design: Retrospective cohort study.
    Setting: Data from the OptumLabs Data Warehouse® which includes de-identified medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees, representing a diverse mixture of ages, ethnicities, and geographical regions across the United States.
    Subjects: Patients prescribed stable, higher-dose opioids for ≥12 months from 2008 to 2018.
    Methods: Tapering was defined as ≥15% relative reduction in average MME/day during any of six overlapping 60-day periods in the initial 7 months of follow-up after the period of stable baseline dosing. Average monthly dose was ascertained during consecutive 60-day periods up to 16 months of follow-up. Linear regression estimated the geometric mean relative dose by tapering status and follow-up duration. Poisson regression estimated the percentage of tapered patients with sustained dose reductions at follow-up and patient-level predictors of failing to sustain tapers.
    Results: The sample included 113,618 patients with 203,920 periods of stable baseline dosing (mean follow-up = 13.7 months). Tapering was initiated during 37,170 follow-up periods (18.2%). After taper initiation, patients had a substantial initial mean dose reduction (geometric mean relative dose .73 [95% CI: .72-.74]) that was sustained through 16 months of follow-up; at which point, 69.8% (95% CI: 69.1%-70.4%) of patients who initiated tapers had a relative dose reduction ≥15%, and 14.2% (95% CI: 13.7%-14.7%) had discontinued opioids. Failure to sustain tapers was significantly less likely among patients with overdose events during follow-up (adjusted incidence rate ratio [aIRR]: .56 [95% CI: .48-.67]) and during more recent years (aIRR: .93 per year after 2008 [95% CI: .92-.94]).
    Conclusions: In an insured and Medicare Advantage population, over two-thirds of patients who initiated opioid dose tapering sustained long-term dose reductions, and the likelihood of sustaining tapers increased substantially from 2008 to 2018.
    MeSH term(s) Aged ; Analgesics, Opioid/therapeutic use ; Drug Tapering ; Humans ; Medicare ; Pharmacies ; Retrospective Studies ; United States
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2021-03-03
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2015903-1
    ISSN 1526-4637 ; 1526-2375
    ISSN (online) 1526-4637
    ISSN 1526-2375
    DOI 10.1093/pm/pnaa470
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    Zs.A 6119: Show issues Location:
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  6. Article ; Online: Trends and Rapidity of Dose Tapering Among Patients Prescribed Long-term Opioid Therapy, 2008-2017.

    Fenton, Joshua J / Agnoli, Alicia L / Xing, Guibo / Hang, Lillian / Altan, Aylin E / Tancredi, Daniel J / Jerant, Anthony / Magnan, Elizabeth

    JAMA network open

    2019  Volume 2, Issue 11, Page(s) e1916271

    Abstract: Importance: A 2016 Centers for Disease Control and Prevention prescribing guideline cautioned against higher-dose long-term opioid therapy and recommended tapering daily opioid doses by approximately 10% per week if the risks outweigh the benefits. ... ...

    Abstract Importance: A 2016 Centers for Disease Control and Prevention prescribing guideline cautioned against higher-dose long-term opioid therapy and recommended tapering daily opioid doses by approximately 10% per week if the risks outweigh the benefits. Warnings have since appeared regarding potential hazards of rapid opioid tapering.
    Objectives: To characterize US trends in opioid dose tapering among patients prescribed long-term opioids from 2008 to 2017 and identify patient-level variables associated with tapering and a more rapid rate of tapering.
    Design, setting, and participants: This retrospective cohort study used deidentified medical and pharmacy claims and enrollment records for 100 031 commercial insurance and Medicare Advantage enrollees, representing a diverse mixture of ages, races/ethnicities, and geographical regions across the United States. Adults with stable, higher-dosage (mean, ≥50 morphine milligram equivalents [MMEs]/d) opioid prescriptions for a 12-month baseline period and 2 or more months of follow-up from January 1, 2008, to December 31, 2017, were included in the study.
    Main outcomes and measures: Tapering was defined as 15% or more relative reduction in mean daily MME during any of 6 overlapping 60-day windows within a 7-month follow-up period. The rate of tapering was computed as the maximum monthly percentage dose reduction.
    Results: Among the 100 031 participants (53 452 [53.4%] women; mean [SD] age, 57.6 [11.8] years), from 2008 to 2015, the age- and sex-standardized percentage of patients tapering daily opioid doses increased from 10.5% to 13.7% (adjusted incidence rate ratio [aIRR] per year, 1.05 [95% CI, 1.05-1.06]) before increasing to 16.2% in 2016 and 22.4% in 2017 (aIRR in 2016-2017 vs 2008-2015, 1.20 [95% CI, 1.16-1.25]). Patient-level covariates associated with tapering included female sex (aIRR, 1.13 [95% CI, 1.10-1.15]) and higher baseline dose (aIRR for ≥300 MMEs/d vs 50-89 MMEs/d, 2.57 [95% CI, 2.48-2.65]). Among patients tapering daily opioid doses, the mean (SD) maximum dose reduction was 27.6% (17.0%) per month, and 18.8% of patients had a maximum tapering rate exceeding 40% per month (ie, faster than 10% per week). More rapid dose reduction was associated with 2016-2017 vs 2008-2015 (adjusted difference, 1.4% [95% CI, 0.8%-2.1%]) and higher baseline dose (adjusted difference, 2.7% [95% CI, 2.2%-3.3%] for 90-149 vs 50-89 MMEs/d).
    Conclusions and relevance: Patients using long-term opioid therapy are increasingly undergoing dose tapering, particularly women and those prescribed higher doses; in addition, dose tapering has become more common since 2016. Many patients undergoing tapering reduce daily doses at a rapid maximum rate.
    MeSH term(s) Adolescent ; Adult ; Age Factors ; Aged ; Analgesics, Opioid/administration & dosage ; Female ; Humans ; Male ; Medicare/statistics & numerical data ; Middle Aged ; Practice Patterns, Physicians'/statistics & numerical data ; Retrospective Studies ; Sex Factors ; United States ; Young Adult
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2019-11-01
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2019.16271
    Database MEDical Literature Analysis and Retrieval System OnLINE

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