Long-term use of hydrocodone vs. oxycodone in primary care.
Acute back pain
Hydrocodone
Long-term opioid use
Opioids
Oxycodone
Primary care
Journal
Drug and alcohol dependence
ISSN: 1879-0046
Titre abrégé: Drug Alcohol Depend
Pays: Ireland
ID NLM: 7513587
Informations de publication
Date de publication:
01 12 2019
01 12 2019
Historique:
received:
09
01
2019
revised:
20
05
2019
accepted:
19
06
2019
pubmed:
11
11
2019
medline:
1
7
2020
entrez:
11
11
2019
Statut:
ppublish
Résumé
Hydrocodone and oxycodone are the Schedule II opioids most often prescribed in primary care. Notwithstanding the dangers of prescription opioid use, the likelihood of long-term use with either drug is presently unknown. Using a retrospective cohort design and data from a commerical healthcare claims repository, we compared the likelihood of long-term use of hydrocodone and oxycodone in primary care patients presenting with acute back pain. Treatment was categorized as long-term if the prescription dates spanned ≥90 days from initial prescription to the run-out date of the last prescription, and included ≥120 days' supply or ≥10 fills. Instrumental variable methods and probit regression were used to model the effect of drug choice on long-term use, estimate the average treatment effect, and correct for confounding by indication. A total of 3,983 patients who were prescribed only hydrocodone or only oxycodone were followed for 270 days in 2016. Long-term opioid use was observed in 320 patients (8%). Controlling for potential confounders including morphine milligram equivalents and dosage, an estimated 12% (95 CI, 10%-14%) treated with hydrocodone transitioned to long-term use vs. 2% (95 CI, 1%-3%) on oxycodone. Among patients who received more than one prescription (n = 1,866), an estimated 23% (95 CI, 19%-26%) treated with hydrocodone transitioned to long-term use vs. 5% (95 CI, 3%-7%) on oxycodone. The difference between drugs was supported in sensitivity and subgroup analyses. Sample selection bias was not detected. Long-term use was substantially greater for patients treated with hydrocodone than oxycodone, despite equianalgesia.
Sections du résumé
BACKGROUND
Hydrocodone and oxycodone are the Schedule II opioids most often prescribed in primary care. Notwithstanding the dangers of prescription opioid use, the likelihood of long-term use with either drug is presently unknown.
METHODS
Using a retrospective cohort design and data from a commerical healthcare claims repository, we compared the likelihood of long-term use of hydrocodone and oxycodone in primary care patients presenting with acute back pain. Treatment was categorized as long-term if the prescription dates spanned ≥90 days from initial prescription to the run-out date of the last prescription, and included ≥120 days' supply or ≥10 fills. Instrumental variable methods and probit regression were used to model the effect of drug choice on long-term use, estimate the average treatment effect, and correct for confounding by indication.
RESULTS
A total of 3,983 patients who were prescribed only hydrocodone or only oxycodone were followed for 270 days in 2016. Long-term opioid use was observed in 320 patients (8%). Controlling for potential confounders including morphine milligram equivalents and dosage, an estimated 12% (95 CI, 10%-14%) treated with hydrocodone transitioned to long-term use vs. 2% (95 CI, 1%-3%) on oxycodone. Among patients who received more than one prescription (n = 1,866), an estimated 23% (95 CI, 19%-26%) treated with hydrocodone transitioned to long-term use vs. 5% (95 CI, 3%-7%) on oxycodone. The difference between drugs was supported in sensitivity and subgroup analyses. Sample selection bias was not detected.
CONCLUSIONS
Long-term use was substantially greater for patients treated with hydrocodone than oxycodone, despite equianalgesia.
Identifiants
pubmed: 31707268
pii: S0376-8716(19)30283-2
doi: 10.1016/j.drugalcdep.2019.06.026
pmc: PMC9338763
mid: NIHMS1824370
pii:
doi:
Substances chimiques
Analgesics, Opioid
0
Hydrocodone
6YKS4Y3WQ7
Oxycodone
CD35PMG570
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
107524Subventions
Organisme : NIMH NIH HHS
ID : P30 MH097488
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK082866
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.
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