1. Treatment of Pain on Opioid Prescribing in Utah, 2002–2009
Evaluating the Impact of Utah Clinical Guidelines on Prescribing Opioids for
Treatment of Pain on Opioid Prescribing in Utah, 2002–2009
Brian C. Sauer1,2, Christy Porusnik3, Chia-Chen Teng1,2, Erin Johnson4, Robert Rolfs3, Jonathan Nebeker1
1VA SLC IDEAS Center, Salt Lake City UT, 2University of Utah Division of Epidemiology, 3University of Utah DFPM, 4Utah Department of Health
Objectives
Quantify changes in opioid prescribing and adverse events before guideline development (pre-period) during development and reporting of opioid concerns (intermittent period) and after promulgation of the Guidelines (post-period).
Descriptive Statistics
Interpretation
 During each period the number of
Acute opioid users was 373,526 for pre, 398,934 intermediate, and 388,669 for the post period.
Intermediate users was 216,043 pre, 242,155 intermediate, and 237,636 for the post period
Chronic users was 31,465 pre, 33,469 intermediate, and 36,364 for the post period
Palliative users was 5,139 pre, 5,735 intermediate, and 5,081 for the post period
Most process and outcome measures improved during the post-guideline periods.
Chronic users had the highest proportion of poly-pharmacy and outcome flags.
Opioid users classified as palliative had the highest proportion of initial methadone dosing violations.
Methods
This study was IRB approved by the University of Utah.
Multiple data sources were used for this analysis including the Utah Controlled Substances Database (CSD), Utah ED encounter database, and the state medical examiner and death certificate databases.
Opioid users were categorized as:
Acute: no period of > 67 days of any opioid coverage with gaps <=7 days within prior 12 months (study period).
Intermittent: Does not meet criteria for denominators Acute, Chronic, Palliative.
Chronic: >180 days of any opioid filled with no gaps >7 days within study period.
Palliative: based on C codes from death certificate data. If died with C code then that period is considered palliative and the period preceding it palliative if falls within 1 year of death.
Flags were compared by opioid user type across the pre-intervention period (07/ /2007), intermittent period (08/ ), and post-period (04/ /2010).
Process flags included the dual use of long- acting opioids, dual use of short-acting opioids, combined use of benzodiazepines and long- acting opioids, methadone titration.
Methadone titration rule:
Index methadone fill with ≤ 6m no methadone.
Rule based on daily Morphine EQ (ME) prior to index fill
If < 30mg ME/day then any methadone use is inappropriate
If < 60mg ME/day then > 15 mg/day methadone is inappropriate
If < 105 ME/day then > 23mg/day methadone is inappropriate
If > 30mg/day then methadone dose is inappropriate
Outcome flags included:
Opioid related ED visits
Opioid related deaths
Denominators for each measure varied.
Denominator: Methadone users by user type
Denominator: Long-acting opioid users by user type
Denominator: Long-acting opioid users by user type
Denominator: Short-acting opioid users by user type
Denominator: Opioid users by user type
Denominator: Opioid users by user type
Risk Ratios
Impact
A decrease in unsafe use of opioids and opioid-related adverse events was observed in Utah since the opioid prescribing guidelines were promulgated and received media attention.
Other historical factors may also be affecting changes in opioid prescribing and adverse events.
Pre-Intervention vs.
Post-intervention
Acknowledgements
CDC : 5 R21 CE
Utah Health Bill 137
VA HSR&D Career Development Award # RCD063002
Contact Information
Intermediate vs. Post-intervention
CCOE