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

Publication date: Jul 18, 2019

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.

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.

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).

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.

Open Access PDF

Alexandridis, A.A., Dasgupta, N., Ringwalt, C.L., Rosamond, W.D., Chelminski, P.R., and Marshall, S.W. Association between opioid analgesic therapy and initiation of buprenorphine management: An analysis of prescription drug monitoring program data. 04490. 2019 PLoS One (15):1.

Concepts Keywords
Addiction Healthcare interactions
Analgesic Drugs
Analgesics Analgesics
Analytic RTT
Benzodiazepine Morphinans
Buprenorphine Drug rehabilitation
Controlled Substance Opioids
Decile Ethers
Dose Response Buprenorphine
Full Agonist Opioid use disorder
Gender Κ-opioid receptor
Healthcare Buprenorphine/naloxone
HR 2
Iatrogenic
Multivariate
North Carolina
Opioid
Opioid Dependence
Pharmacies
Prescription Drug
Sublingual

Semantics

Type Source Name
drug DRUGBANK Buprenorphine
disease MESH opioid dependence
drug DRUGBANK Benzodiazepine
disease MESH multiple
disease MESH diagnosis
disease MESH Substance Abuse
disease MESH chronic pain
drug DRUGBANK Trestolone
disease MESH mental disorders
drug DRUGBANK Ilex paraguariensis leaf
drug DRUGBANK Naltrexone
drug DRUGBANK Methadone
drug DRUGBANK Bean
disease MESH community
drug DRUGBANK Alpha-1-proteinase inhibitor
drug DRUGBANK Morphine
drug DRUGBANK Tramadol
disease MESH growth
drug DRUGBANK Oxycodone
drug DRUGBANK Hydrocodone
drug DRUGBANK Codeine
drug DRUGBANK Fentanyl
drug DRUGBANK Coenzyme M
drug DRUGBANK Acetaminophen
drug DRUGBANK Hexadecanal
drug DRUGBANK Acetylsalicylic acid
disease MESH contraindication
disease MESH comorbidity
disease MESH anxiety
disease MESH sleep disorders
disease MESH privacy
drug DRUGBANK Diamorphine
disease MESH death
disease MESH weaning
drug DRUGBANK Ethanol
disease MESH alcohol dependence

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