The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
L. Zhou - One of the best experts on this subject based on the ideXlab platform.
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association between dual trajectories of opioid and Gabapentinoid use and healthcare expenditures among us medicare beneficiaries
Value in Health, 2021Co-Authors: L. Zhou, Sandipan Bhattacharjee, Patrick J. Tighe, Daniel C. Malone, Marion K. Slack, Debbie L Wilson, Gary M. Reisfield, Kent C Kwoh, Weihsuan LociganicAbstract:Abstract Objectives Little is known about relationships between opioid- and Gabapentinoid-use patterns and healthcare expenditures that may be affected by pain management and risk of adverse outcomes. This study examined the association between patients’ opioid and Gabapentinoid prescription filling/refilling trajectories and direct medical expenditures in US Medicare. Methods This cross-sectional study included a 5% national sample (2011-2016) of fee-for-service beneficiaries with fibromyalgia, low back pain, neuropathy, or osteoarthritis newly initiating opioids or Gabapentinoids. Using group-based multitrajectory modeling, this study identified patients’ distinct opioid and Gabapentinoid (OPI-GABA) dose and duration patterns, based on standardized daily doses, within a year of initiating opioids and/or Gabapentinoids. Concurrent direct medical expenditures within the same year were estimated using inverse probability of treatment weighted multivariable generalized linear regression, adjusting for sociodemographic and health status factors. Results Among 67 827 eligible beneficiaries (mean age ± SD = 63.6 ± 14.8 years, female = 65.8%, white = 77.1%), 11 distinct trajectories were identified (3 opioid-only, 4 Gabapentinoid-only, and 4 concurrent OPI-GABA trajectories). Compared with opioid-only early discontinuers ($13 830, 95% confidence interval = $13 643-14 019), Gabapentinoid-only early discontinuers and consistent low-dose and moderate-dose Gabapentinoid-only users were associated with 11% to 23% lower health expenditures (adjusted mean expenditure = $10 607-$11 713). Consistent low-dose opioid-only users, consistent high-dose opioid-only users, consistent low-dose OPI-GABA users, consistent low-dose opioid and high-dose Gabapentinoid users, and consistent high-dose opioid and moderate-dose Gabapentinoid users were associated with 14% to 106% higher healthcare expenditures (adjusted mean expenditure = $15 721-$28 464). Conclusions Dose and duration patterns of concurrent OPI-GABA varied substantially among fee-for-service Medicare beneficiaries. Consistent opioid-only users and all concurrent OPI-GABA users were associated with higher healthcare expenditures compared to opioid-only discontinuers.
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Dual-trajectories of opioid and Gabapentinoid use and risk of subsequent drug overdose among Medicare beneficiaries in the United States: a retrospective cohort study.
Addiction, 2020Co-Authors: L. Zhou, Sandipan Bhattacharjee, C. Kent Kwoh, Patrick J. Tighe, Daniel C. Malone, Marion K. Slack, Debbie L Wilson, Gary M. Reisfield, Ching Yuan Chang, Wei-hsuan Lo-ciganicAbstract:BACKGROUND AND AIMS Little is known about opioid and Gabapentinoid (OPI-GABA) use duration and dose patterns' associations with adverse outcome risks. We examined associations between OPI-GABA dose and duration trajectories and subsequent drug overdose. DESIGN Retrospective cohort study. SETTING US Medicare. PARTICIPANTS Using a 5% sample (2011-16), we identified 71 005 fee-for-service Medicare beneficiaries with fibromyalgia, low back pain, neuropathy and/or osteoarthritis initiating OPIs and/or GABAs [mean age ± standard deviation (SD) = 65.5 ± 14.5 years, female = 68.1%, white = 76.8%]. MEASUREMENTS Group-based multi-trajectory models identified distinct OPI-GABA use patterns during the year of OPI and/or GABA initiation, based on weekly average standardized daily dose (i.e. OPIs = morphine milligram equivalent, GABAs = minimum effective daily dose). We estimated models with three to 12 trajectories and selected the best model based on Bayesian information criterion (BIC) and Nagin's criteria. We estimated risk of time to first drug overdose diagnosis within 12 months following the index year, adjusting for socio-demographic and health factors using inverse probability of treatment weighted multivariable Cox proportional hazards models. FINDINGS We identified 10 distinct trajectories (BIC = -1 176 954; OPI-only = 3, GABA-only = 3, OPI-GABA = 4). Compared with OPI-only early discontinuers (40.6% of the cohort), 1-year drug overdose risk varied by trajectory group: consistent low-dose OPI-only users [16.6%; hazard ratio (HR) = 1.47, 95% confidence interval (CI) = 1.19-1.82], consistent high-dose OPI-only users (1.8%; HR = 4.57, 95% CI = 2.99-6.98), GABA-only early discontinuers (12.5%; HR = 1.39, 95% CI = 1.09-1.77), consistent low-dose GABA-only users (11.0%; HR = 1.44, 95% CI = 1.12-1.85), consistent high-dose GABA-only users (3.1%; HR = 1.43, 95% CI = 0.94-2.17), early discontinuation of OPIs and consistent low-dose GABA users (6.9%; HR = 1.24, 95% CI = 0.90-1.69), consistent low-dose OPI-GABA users (3.4%; HR = 2.49, 95% CI = 1.76-3.52), consistent low-dose OPI and high-dose GABA users (3.2%; HR = 2.46, 95% CI = 1.71-3.53) and consistent high-dose OPI and moderate-dose GABA users (0.9%; HR = 7.22, 95% CI = 4.46-11.69). CONCLUSIONS Risk of drug overdose varied substantially among US Medicare beneficiaries on different use trajectories of opioids and Gabapentinoids. High-dose opioid-only users and all consistent opioid and Gabapentinoid users (regardless of doses) had more than double the risk of subsequent drug overdose compared with opioid-only early discontinuers.
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Trends, Patient and Prescriber Characteristics in Gabapentinoid Use in a Sample of United States Ambulatory Care Visits from 2003 to 2016.
Journal of Clinical Medicine, 2019Co-Authors: L. Zhou, Sandipan Bhattacharjee, C. Kent Kwoh, Patrick J. Tighe, Daniel C. Malone, Marion K. Slack, Debbie L Wilson, Joshua D. Brown, Wei-hsuan Lo-ciganicAbstract:Increasing Gabapentinoid use has raised concerns of misuse and abuse in the United States (US). Little is known about the characteristics of Gabapentinoid use in general clinical practice over time. This cross-sectional study used data from the National Ambulatory Medical Care Survey. We examined the trends of patient and prescriber characteristics and the diagnoses associated with US ambulatory care visits involving Gabapentinoids for adult visits from 2003 to 2016. Using multivariable logistic regression, we estimated the adjusted proportion of Gabapentinoid-involved visits among all visits and tested for trend significance. Among the weighted estimate of 260.1 million Gabapentinoid-involved visits (aged 18-64 years: 61.8%; female: 61.9%; white: 85.5%), the adjusted annual proportion of Gabapentinoid-involved visits nearly quadrupled from 2003 to 2016 (9.1 to 34.9 per 1000 visits; Ptrend < 0.0001), driven mainly by gabapentin. Nearly half had concurrent use with opioids (32.9%) or benzodiazepines (15.3%). Primary care physicians (45.8%), neurologists (8.2%), surgeons (6.2%), and psychiatrists (4.8%) prescribed two-thirds of the Gabapentinoids. Most (96.6%) of the Gabapentinoid visits did not have an approved indication for Gabapentinoids among the first three diagnoses. Among US ambulatory care visits from 2003 to 2016, Gabapentinoid use increased substantially, commonly prescribed by primary care physicians.
Kirk E. Evoy - One of the best experts on this subject based on the ideXlab platform.
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Gabapentinoid pharmacology in the context of emerging misuse liability
The Journal of Clinical Pharmacology, 2021Co-Authors: Kirk E. Evoy, Jordan R Covvey, Alyssa M Peckham, Kevin TidgewellAbstract:This article will review the epidemiology and pharmacology of Gabapentinoids (gabapentin and pregabalin) relevant to their emerging misuse potential and provide guidance for clinical and regulatory management. Gabapentinoids are γ-aminobutyric acid analogues that produce their therapeutic effects by inhibiting voltage-gated calcium channels and decreasing neurotransmitter release. Recently Gabapentinoid prescribing and use have increased tremendously. Although traditionally thought to possess a favorable safety profile, Gabapentinoid misuse has also risen significantly. Gabapentinoid misuse generally occurs in combination with other substances, most notably opioids, and may be for purposes of eliciting euphoric effects, enhancing the effects of other substances, or self-treating conditions such as withdrawal, pain, anxiety, or insomnia. Given its faster onset, increased bioavailability and potency, and nonsaturable absorption, pregabalin's pharmacokinetics theoretically enhance its misuse liability versus gabapentin. However, gabapentin can produce similar euphoric effects, and epidemiologic studies have identified higher rates of gabapentin misuse in the United States, likely because of greater availability and less regulated prescribing. Although adverse events of Gabapentinoid-only ingestion are relatively benign, a growing body of evidence indicates that Gabapentinoids significantly increase opioid-related morbidity and mortality when used concomitantly. In addition, significant withdrawal effects may occur on abrupt discontinuation. As a result of these trends, several US states have begun to further regulate Gabapentinoid prescribing, reclassifying it as a controlled substance or mandating reporting to local prescription drug-monitoring programs. Although increased regulation of gabapentin prescribing may be warranted, harm reduction efforts and increased patient and provider education are necessary to mitigate this concerning Gabapentinoid misuse trend.
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prevalence of and factors associated with Gabapentinoid use and misuse among texas medicaid recipients
Clinical Drug Investigation, 2021Co-Authors: Elizabeth A Ibiloye, Kirk E. Evoy, Alyssa M Peckham, Jamie C Barner, Kenneth A Lawson, Karen L RascatiAbstract:Gabapentin and pregabalin have been considered relatively safe opioid-sparing adjuncts for pain management. However, rising prescribing trends, presence of Gabapentinoids in opioid-related overdoses, and the growing body of evidence regarding Gabapentinoid misuse and abuse, have caused Gabapentinoids to emerge as a drug class of public health concern. This study aimed to assess the prevalence of, and factors associated with Gabapentinoid use and misuse. This retrospective study of Texas Medicaid data from 1/1/2012 to 30/8/2016 included patients aged 18–63 years at index date, with ≥ 1 Gabapentinoid prescription, and continuously enrolled 6 months pre-index and 12 months post-index. Gabapentinoid misuse was defined as ≥ 3 claims exceeding daily doses of 3600 mg for gabapentin and 600 mg for pregabalin. Age, gender, concurrent opioid use, neuropathic pain diagnoses and Gabapentinoid type were independent variables. Descriptive and inferential statistics were used. Of included subjects (N = 39,000), 0.2% (N = 81) met study criteria for Gabapentinoid misuse. Overall, the majority (76.4%) of Gabapentinoid users were aged 41–63 years with a mean ± SD age of 48.2 ± 10.7 years. Those patients meeting the study criteria for Gabapentinoid misuse were significantly younger (45.1 ± 11.0 vs 48.2 ± 10.7, p = 0.0084). Majority of the study sample was female (68.1%). However, a significantly higher proportion of males met the study criteria for Gabapentinoid misuse compared to females (0.3% vs 0.2%, p = 0.0079). Approximately one-half (51.9%) of the study sample had neuropathic pain, and Gabapentinoid misuse was significantly higher in neuropathic pain patients compared to those without neuropathic pain (0.3% vs 0.1%, p = 0.0078). Over three-quarters (77.4%) of patients were using gabapentin; however, Gabapentinoid misuse was significantly higher among pregabalin users (0.4% vs 0.2%, p = 0.0003). Approximately 20% (17.3%) of Gabapentinoid users had ≥ 90 days of concurrent opioid use. However, there was no significant difference in Gabapentinoid misuse among patients with concurrent opioid use compared to patients without (0.3% vs 0.2%, p = 0.1440). Factors significantly associated with misuse included: male sex (odds ratio [OR] 0.486; 95% confidence interval [CI] 0.313–0.756; p = 0.0013); neuropathic pain (OR 2.065; 95% CI 1.289–3.308; p = 0.0026); and pregabalin versus gabapentin use (OR 2.337, 95% CI 1.492–3.661; p = 0.0002). Concurrent opioid use was not significantly associated with Gabapentinoid misuse (OR 1.542, 95% CI 0.920–2.586; p = 0.1006). Prevalence of Gabapentinoid misuse was low (0.2%) among Texas Medicaid recipients. Younger age, male gender, neuropathic pain diagnosis and pregabalin use were significantly associated with higher levels of Gabapentinoid misuse.
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Gabapentinoid misuse abuse and non prescribed obtainment in a united states general population sample
International Journal of Clinical Pharmacy, 2021Co-Authors: Kirk E. Evoy, Jordan R Covvey, Alyssa M Peckham, Kelly R RevelesAbstract:Background Reports of Gabapentinoid (gabapentin and pregabalin) misuse are on the rise, but few studies have assessed this within the general US population. Objective Describe lifetime misuse/abuse/non-prescribed obtainment of Gabapentinoids and descriptive characteristics associated with such actions in a US general population sample. Setting This cross-sectional questionnaire was administered online by Qualtrics® research panel aggregator via quota-based sampling. Methods Data were collected from a sample of respondents that mirrored the general US population aged 18–59 years with regards to age, geographic region, ethnicity, income, and education level, based on most recent census data. Misuse/abuse/non-prescribed obtainment was collectively defined as use of a Gabapentinoid for reasons other than a diagnosed medical condition, using with the intention of altering one’s state of consciousness, or obtaining without a prescription. A multivariable logistic regression model was created to predict misuse/abuse/non-prescribed obtainment of Gabapentinoids, incorporating relevant covariates. Main outcome measure Proportion of sample indicating lifetime misuse/abuse/non-prescribed obtainment of Gabapentinoids. Results Among 1,843 respondents, 121 (6.6%) reported Gabapentinoid misuse/abuse/non-prescribed obtainment. Specifically, 2.1% (n = 39) and 1.5% (n = 27) of respondents for gabapentin and pregabalin, respectively, met study criteria for abuse. Opioids were the most common medication co-administered with Gabapentinoids (among 50–70% of respondents) for misuse/abuse. Previous treatment for addiction (OR: 2.61, 95% CI: 1.32–5.14, p = 0.005) and the total attitudinal risk score (OR: 1.14, 95% CI: 1.09–1.19, p < 0.001) were associated with Gabapentinoid misuse/abuse/non-prescribed obtainment. Conclusion Among those surveyed, 6.6% reported previous Gabapentinoid misuse/abuse/non-prescribed obtainment, providing one of the first estimates within a nationally distributed, US general population sample.
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reports of gabapentin and pregabalin abuse misuse dependence or overdose an analysis of the food and drug administration adverse events reporting system faers
Research in Social & Administrative Pharmacy, 2019Co-Authors: Kirk E. Evoy, Jordan R Covvey, Alyssa M Peckham, Leslie Ochs, Kyle E HultgrenAbstract:Abstract Background Reports of Gabapentinoid (gabapentin and pregabalin) misuse have increased in recent years. Pharmacovigilance data from the Food and Drug Administration Adverse Event Reporting System (FAERS) provides a useful examination of adverse drug event (ADE) reporting for safety signal detection. Objective This study was conducted to analyze epidemiological information on the nature and extent of gabapentin/pregabalin abuse utilizing the FAERS database. Methods A query was designed utilizing SafeRx, an indexed, searchable database of FAERS data from October 2012–December 2016. All-cause and abuse-related (including abuse/misuse/dependence/overdose events) ADE reports for gabapentin and pregabalin were isolated, as well as limited demographic data. The proportional reporting ratio (PRR) was calculated to compare signal detection. Results A total of 10,038 all-cause ADEs were reported to FAERS for gabapentin, including 576 (5.7%) abuse-related events. For pregabalin, 571 all-cause ADEs were identified, including 58 (10.2%) related to abuse. Compared to all-cause ADEs, those involved in abuse-related events were younger and more likely to be male. The PRR of pregabalin versus gabapentin abuse-related events was 1.77. Conclusion Though not traditionally thought of as drugs of abuse, over 600 cases of Gabapentinoid abuse were reported in the time frame analyzed, prompting the need for further study and regulatory investigation.
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abuse and misuse of pregabalin and gabapentin
Drugs, 2017Co-Authors: Kirk E. Evoy, Megan D. Morrison, Stephen R. SakladAbstract:Background Gabapentinoid (pregabalin and gabapentin) abuse is increasingly being reported.
Wei-hsuan Lo-ciganic - One of the best experts on this subject based on the ideXlab platform.
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Dual-trajectories of opioid and Gabapentinoid use and risk of subsequent drug overdose among Medicare beneficiaries in the United States: a retrospective cohort study.
Addiction, 2020Co-Authors: L. Zhou, Sandipan Bhattacharjee, C. Kent Kwoh, Patrick J. Tighe, Daniel C. Malone, Marion K. Slack, Debbie L Wilson, Gary M. Reisfield, Ching Yuan Chang, Wei-hsuan Lo-ciganicAbstract:BACKGROUND AND AIMS Little is known about opioid and Gabapentinoid (OPI-GABA) use duration and dose patterns' associations with adverse outcome risks. We examined associations between OPI-GABA dose and duration trajectories and subsequent drug overdose. DESIGN Retrospective cohort study. SETTING US Medicare. PARTICIPANTS Using a 5% sample (2011-16), we identified 71 005 fee-for-service Medicare beneficiaries with fibromyalgia, low back pain, neuropathy and/or osteoarthritis initiating OPIs and/or GABAs [mean age ± standard deviation (SD) = 65.5 ± 14.5 years, female = 68.1%, white = 76.8%]. MEASUREMENTS Group-based multi-trajectory models identified distinct OPI-GABA use patterns during the year of OPI and/or GABA initiation, based on weekly average standardized daily dose (i.e. OPIs = morphine milligram equivalent, GABAs = minimum effective daily dose). We estimated models with three to 12 trajectories and selected the best model based on Bayesian information criterion (BIC) and Nagin's criteria. We estimated risk of time to first drug overdose diagnosis within 12 months following the index year, adjusting for socio-demographic and health factors using inverse probability of treatment weighted multivariable Cox proportional hazards models. FINDINGS We identified 10 distinct trajectories (BIC = -1 176 954; OPI-only = 3, GABA-only = 3, OPI-GABA = 4). Compared with OPI-only early discontinuers (40.6% of the cohort), 1-year drug overdose risk varied by trajectory group: consistent low-dose OPI-only users [16.6%; hazard ratio (HR) = 1.47, 95% confidence interval (CI) = 1.19-1.82], consistent high-dose OPI-only users (1.8%; HR = 4.57, 95% CI = 2.99-6.98), GABA-only early discontinuers (12.5%; HR = 1.39, 95% CI = 1.09-1.77), consistent low-dose GABA-only users (11.0%; HR = 1.44, 95% CI = 1.12-1.85), consistent high-dose GABA-only users (3.1%; HR = 1.43, 95% CI = 0.94-2.17), early discontinuation of OPIs and consistent low-dose GABA users (6.9%; HR = 1.24, 95% CI = 0.90-1.69), consistent low-dose OPI-GABA users (3.4%; HR = 2.49, 95% CI = 1.76-3.52), consistent low-dose OPI and high-dose GABA users (3.2%; HR = 2.46, 95% CI = 1.71-3.53) and consistent high-dose OPI and moderate-dose GABA users (0.9%; HR = 7.22, 95% CI = 4.46-11.69). CONCLUSIONS Risk of drug overdose varied substantially among US Medicare beneficiaries on different use trajectories of opioids and Gabapentinoids. High-dose opioid-only users and all consistent opioid and Gabapentinoid users (regardless of doses) had more than double the risk of subsequent drug overdose compared with opioid-only early discontinuers.
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Trends, Patient and Prescriber Characteristics in Gabapentinoid Use in a Sample of United States Ambulatory Care Visits from 2003 to 2016.
Journal of Clinical Medicine, 2019Co-Authors: L. Zhou, Sandipan Bhattacharjee, C. Kent Kwoh, Patrick J. Tighe, Daniel C. Malone, Marion K. Slack, Debbie L Wilson, Joshua D. Brown, Wei-hsuan Lo-ciganicAbstract:Increasing Gabapentinoid use has raised concerns of misuse and abuse in the United States (US). Little is known about the characteristics of Gabapentinoid use in general clinical practice over time. This cross-sectional study used data from the National Ambulatory Medical Care Survey. We examined the trends of patient and prescriber characteristics and the diagnoses associated with US ambulatory care visits involving Gabapentinoids for adult visits from 2003 to 2016. Using multivariable logistic regression, we estimated the adjusted proportion of Gabapentinoid-involved visits among all visits and tested for trend significance. Among the weighted estimate of 260.1 million Gabapentinoid-involved visits (aged 18-64 years: 61.8%; female: 61.9%; white: 85.5%), the adjusted annual proportion of Gabapentinoid-involved visits nearly quadrupled from 2003 to 2016 (9.1 to 34.9 per 1000 visits; Ptrend < 0.0001), driven mainly by gabapentin. Nearly half had concurrent use with opioids (32.9%) or benzodiazepines (15.3%). Primary care physicians (45.8%), neurologists (8.2%), surgeons (6.2%), and psychiatrists (4.8%) prescribed two-thirds of the Gabapentinoids. Most (96.6%) of the Gabapentinoid visits did not have an approved indication for Gabapentinoids among the first three diagnoses. Among US ambulatory care visits from 2003 to 2016, Gabapentinoid use increased substantially, commonly prescribed by primary care physicians.
Patrick J. Tighe - One of the best experts on this subject based on the ideXlab platform.
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association between dual trajectories of opioid and Gabapentinoid use and healthcare expenditures among us medicare beneficiaries
Value in Health, 2021Co-Authors: L. Zhou, Sandipan Bhattacharjee, Patrick J. Tighe, Daniel C. Malone, Marion K. Slack, Debbie L Wilson, Gary M. Reisfield, Kent C Kwoh, Weihsuan LociganicAbstract:Abstract Objectives Little is known about relationships between opioid- and Gabapentinoid-use patterns and healthcare expenditures that may be affected by pain management and risk of adverse outcomes. This study examined the association between patients’ opioid and Gabapentinoid prescription filling/refilling trajectories and direct medical expenditures in US Medicare. Methods This cross-sectional study included a 5% national sample (2011-2016) of fee-for-service beneficiaries with fibromyalgia, low back pain, neuropathy, or osteoarthritis newly initiating opioids or Gabapentinoids. Using group-based multitrajectory modeling, this study identified patients’ distinct opioid and Gabapentinoid (OPI-GABA) dose and duration patterns, based on standardized daily doses, within a year of initiating opioids and/or Gabapentinoids. Concurrent direct medical expenditures within the same year were estimated using inverse probability of treatment weighted multivariable generalized linear regression, adjusting for sociodemographic and health status factors. Results Among 67 827 eligible beneficiaries (mean age ± SD = 63.6 ± 14.8 years, female = 65.8%, white = 77.1%), 11 distinct trajectories were identified (3 opioid-only, 4 Gabapentinoid-only, and 4 concurrent OPI-GABA trajectories). Compared with opioid-only early discontinuers ($13 830, 95% confidence interval = $13 643-14 019), Gabapentinoid-only early discontinuers and consistent low-dose and moderate-dose Gabapentinoid-only users were associated with 11% to 23% lower health expenditures (adjusted mean expenditure = $10 607-$11 713). Consistent low-dose opioid-only users, consistent high-dose opioid-only users, consistent low-dose OPI-GABA users, consistent low-dose opioid and high-dose Gabapentinoid users, and consistent high-dose opioid and moderate-dose Gabapentinoid users were associated with 14% to 106% higher healthcare expenditures (adjusted mean expenditure = $15 721-$28 464). Conclusions Dose and duration patterns of concurrent OPI-GABA varied substantially among fee-for-service Medicare beneficiaries. Consistent opioid-only users and all concurrent OPI-GABA users were associated with higher healthcare expenditures compared to opioid-only discontinuers.
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Dual-trajectories of opioid and Gabapentinoid use and risk of subsequent drug overdose among Medicare beneficiaries in the United States: a retrospective cohort study.
Addiction, 2020Co-Authors: L. Zhou, Sandipan Bhattacharjee, C. Kent Kwoh, Patrick J. Tighe, Daniel C. Malone, Marion K. Slack, Debbie L Wilson, Gary M. Reisfield, Ching Yuan Chang, Wei-hsuan Lo-ciganicAbstract:BACKGROUND AND AIMS Little is known about opioid and Gabapentinoid (OPI-GABA) use duration and dose patterns' associations with adverse outcome risks. We examined associations between OPI-GABA dose and duration trajectories and subsequent drug overdose. DESIGN Retrospective cohort study. SETTING US Medicare. PARTICIPANTS Using a 5% sample (2011-16), we identified 71 005 fee-for-service Medicare beneficiaries with fibromyalgia, low back pain, neuropathy and/or osteoarthritis initiating OPIs and/or GABAs [mean age ± standard deviation (SD) = 65.5 ± 14.5 years, female = 68.1%, white = 76.8%]. MEASUREMENTS Group-based multi-trajectory models identified distinct OPI-GABA use patterns during the year of OPI and/or GABA initiation, based on weekly average standardized daily dose (i.e. OPIs = morphine milligram equivalent, GABAs = minimum effective daily dose). We estimated models with three to 12 trajectories and selected the best model based on Bayesian information criterion (BIC) and Nagin's criteria. We estimated risk of time to first drug overdose diagnosis within 12 months following the index year, adjusting for socio-demographic and health factors using inverse probability of treatment weighted multivariable Cox proportional hazards models. FINDINGS We identified 10 distinct trajectories (BIC = -1 176 954; OPI-only = 3, GABA-only = 3, OPI-GABA = 4). Compared with OPI-only early discontinuers (40.6% of the cohort), 1-year drug overdose risk varied by trajectory group: consistent low-dose OPI-only users [16.6%; hazard ratio (HR) = 1.47, 95% confidence interval (CI) = 1.19-1.82], consistent high-dose OPI-only users (1.8%; HR = 4.57, 95% CI = 2.99-6.98), GABA-only early discontinuers (12.5%; HR = 1.39, 95% CI = 1.09-1.77), consistent low-dose GABA-only users (11.0%; HR = 1.44, 95% CI = 1.12-1.85), consistent high-dose GABA-only users (3.1%; HR = 1.43, 95% CI = 0.94-2.17), early discontinuation of OPIs and consistent low-dose GABA users (6.9%; HR = 1.24, 95% CI = 0.90-1.69), consistent low-dose OPI-GABA users (3.4%; HR = 2.49, 95% CI = 1.76-3.52), consistent low-dose OPI and high-dose GABA users (3.2%; HR = 2.46, 95% CI = 1.71-3.53) and consistent high-dose OPI and moderate-dose GABA users (0.9%; HR = 7.22, 95% CI = 4.46-11.69). CONCLUSIONS Risk of drug overdose varied substantially among US Medicare beneficiaries on different use trajectories of opioids and Gabapentinoids. High-dose opioid-only users and all consistent opioid and Gabapentinoid users (regardless of doses) had more than double the risk of subsequent drug overdose compared with opioid-only early discontinuers.
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Trends, Patient and Prescriber Characteristics in Gabapentinoid Use in a Sample of United States Ambulatory Care Visits from 2003 to 2016.
Journal of Clinical Medicine, 2019Co-Authors: L. Zhou, Sandipan Bhattacharjee, C. Kent Kwoh, Patrick J. Tighe, Daniel C. Malone, Marion K. Slack, Debbie L Wilson, Joshua D. Brown, Wei-hsuan Lo-ciganicAbstract:Increasing Gabapentinoid use has raised concerns of misuse and abuse in the United States (US). Little is known about the characteristics of Gabapentinoid use in general clinical practice over time. This cross-sectional study used data from the National Ambulatory Medical Care Survey. We examined the trends of patient and prescriber characteristics and the diagnoses associated with US ambulatory care visits involving Gabapentinoids for adult visits from 2003 to 2016. Using multivariable logistic regression, we estimated the adjusted proportion of Gabapentinoid-involved visits among all visits and tested for trend significance. Among the weighted estimate of 260.1 million Gabapentinoid-involved visits (aged 18-64 years: 61.8%; female: 61.9%; white: 85.5%), the adjusted annual proportion of Gabapentinoid-involved visits nearly quadrupled from 2003 to 2016 (9.1 to 34.9 per 1000 visits; Ptrend < 0.0001), driven mainly by gabapentin. Nearly half had concurrent use with opioids (32.9%) or benzodiazepines (15.3%). Primary care physicians (45.8%), neurologists (8.2%), surgeons (6.2%), and psychiatrists (4.8%) prescribed two-thirds of the Gabapentinoids. Most (96.6%) of the Gabapentinoid visits did not have an approved indication for Gabapentinoids among the first three diagnoses. Among US ambulatory care visits from 2003 to 2016, Gabapentinoid use increased substantially, commonly prescribed by primary care physicians.
Debbie L Wilson - One of the best experts on this subject based on the ideXlab platform.
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association between dual trajectories of opioid and Gabapentinoid use and healthcare expenditures among us medicare beneficiaries
Value in Health, 2021Co-Authors: L. Zhou, Sandipan Bhattacharjee, Patrick J. Tighe, Daniel C. Malone, Marion K. Slack, Debbie L Wilson, Gary M. Reisfield, Kent C Kwoh, Weihsuan LociganicAbstract:Abstract Objectives Little is known about relationships between opioid- and Gabapentinoid-use patterns and healthcare expenditures that may be affected by pain management and risk of adverse outcomes. This study examined the association between patients’ opioid and Gabapentinoid prescription filling/refilling trajectories and direct medical expenditures in US Medicare. Methods This cross-sectional study included a 5% national sample (2011-2016) of fee-for-service beneficiaries with fibromyalgia, low back pain, neuropathy, or osteoarthritis newly initiating opioids or Gabapentinoids. Using group-based multitrajectory modeling, this study identified patients’ distinct opioid and Gabapentinoid (OPI-GABA) dose and duration patterns, based on standardized daily doses, within a year of initiating opioids and/or Gabapentinoids. Concurrent direct medical expenditures within the same year were estimated using inverse probability of treatment weighted multivariable generalized linear regression, adjusting for sociodemographic and health status factors. Results Among 67 827 eligible beneficiaries (mean age ± SD = 63.6 ± 14.8 years, female = 65.8%, white = 77.1%), 11 distinct trajectories were identified (3 opioid-only, 4 Gabapentinoid-only, and 4 concurrent OPI-GABA trajectories). Compared with opioid-only early discontinuers ($13 830, 95% confidence interval = $13 643-14 019), Gabapentinoid-only early discontinuers and consistent low-dose and moderate-dose Gabapentinoid-only users were associated with 11% to 23% lower health expenditures (adjusted mean expenditure = $10 607-$11 713). Consistent low-dose opioid-only users, consistent high-dose opioid-only users, consistent low-dose OPI-GABA users, consistent low-dose opioid and high-dose Gabapentinoid users, and consistent high-dose opioid and moderate-dose Gabapentinoid users were associated with 14% to 106% higher healthcare expenditures (adjusted mean expenditure = $15 721-$28 464). Conclusions Dose and duration patterns of concurrent OPI-GABA varied substantially among fee-for-service Medicare beneficiaries. Consistent opioid-only users and all concurrent OPI-GABA users were associated with higher healthcare expenditures compared to opioid-only discontinuers.
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Dual-trajectories of opioid and Gabapentinoid use and risk of subsequent drug overdose among Medicare beneficiaries in the United States: a retrospective cohort study.
Addiction, 2020Co-Authors: L. Zhou, Sandipan Bhattacharjee, C. Kent Kwoh, Patrick J. Tighe, Daniel C. Malone, Marion K. Slack, Debbie L Wilson, Gary M. Reisfield, Ching Yuan Chang, Wei-hsuan Lo-ciganicAbstract:BACKGROUND AND AIMS Little is known about opioid and Gabapentinoid (OPI-GABA) use duration and dose patterns' associations with adverse outcome risks. We examined associations between OPI-GABA dose and duration trajectories and subsequent drug overdose. DESIGN Retrospective cohort study. SETTING US Medicare. PARTICIPANTS Using a 5% sample (2011-16), we identified 71 005 fee-for-service Medicare beneficiaries with fibromyalgia, low back pain, neuropathy and/or osteoarthritis initiating OPIs and/or GABAs [mean age ± standard deviation (SD) = 65.5 ± 14.5 years, female = 68.1%, white = 76.8%]. MEASUREMENTS Group-based multi-trajectory models identified distinct OPI-GABA use patterns during the year of OPI and/or GABA initiation, based on weekly average standardized daily dose (i.e. OPIs = morphine milligram equivalent, GABAs = minimum effective daily dose). We estimated models with three to 12 trajectories and selected the best model based on Bayesian information criterion (BIC) and Nagin's criteria. We estimated risk of time to first drug overdose diagnosis within 12 months following the index year, adjusting for socio-demographic and health factors using inverse probability of treatment weighted multivariable Cox proportional hazards models. FINDINGS We identified 10 distinct trajectories (BIC = -1 176 954; OPI-only = 3, GABA-only = 3, OPI-GABA = 4). Compared with OPI-only early discontinuers (40.6% of the cohort), 1-year drug overdose risk varied by trajectory group: consistent low-dose OPI-only users [16.6%; hazard ratio (HR) = 1.47, 95% confidence interval (CI) = 1.19-1.82], consistent high-dose OPI-only users (1.8%; HR = 4.57, 95% CI = 2.99-6.98), GABA-only early discontinuers (12.5%; HR = 1.39, 95% CI = 1.09-1.77), consistent low-dose GABA-only users (11.0%; HR = 1.44, 95% CI = 1.12-1.85), consistent high-dose GABA-only users (3.1%; HR = 1.43, 95% CI = 0.94-2.17), early discontinuation of OPIs and consistent low-dose GABA users (6.9%; HR = 1.24, 95% CI = 0.90-1.69), consistent low-dose OPI-GABA users (3.4%; HR = 2.49, 95% CI = 1.76-3.52), consistent low-dose OPI and high-dose GABA users (3.2%; HR = 2.46, 95% CI = 1.71-3.53) and consistent high-dose OPI and moderate-dose GABA users (0.9%; HR = 7.22, 95% CI = 4.46-11.69). CONCLUSIONS Risk of drug overdose varied substantially among US Medicare beneficiaries on different use trajectories of opioids and Gabapentinoids. High-dose opioid-only users and all consistent opioid and Gabapentinoid users (regardless of doses) had more than double the risk of subsequent drug overdose compared with opioid-only early discontinuers.
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Trends, Patient and Prescriber Characteristics in Gabapentinoid Use in a Sample of United States Ambulatory Care Visits from 2003 to 2016.
Journal of Clinical Medicine, 2019Co-Authors: L. Zhou, Sandipan Bhattacharjee, C. Kent Kwoh, Patrick J. Tighe, Daniel C. Malone, Marion K. Slack, Debbie L Wilson, Joshua D. Brown, Wei-hsuan Lo-ciganicAbstract:Increasing Gabapentinoid use has raised concerns of misuse and abuse in the United States (US). Little is known about the characteristics of Gabapentinoid use in general clinical practice over time. This cross-sectional study used data from the National Ambulatory Medical Care Survey. We examined the trends of patient and prescriber characteristics and the diagnoses associated with US ambulatory care visits involving Gabapentinoids for adult visits from 2003 to 2016. Using multivariable logistic regression, we estimated the adjusted proportion of Gabapentinoid-involved visits among all visits and tested for trend significance. Among the weighted estimate of 260.1 million Gabapentinoid-involved visits (aged 18-64 years: 61.8%; female: 61.9%; white: 85.5%), the adjusted annual proportion of Gabapentinoid-involved visits nearly quadrupled from 2003 to 2016 (9.1 to 34.9 per 1000 visits; Ptrend < 0.0001), driven mainly by gabapentin. Nearly half had concurrent use with opioids (32.9%) or benzodiazepines (15.3%). Primary care physicians (45.8%), neurologists (8.2%), surgeons (6.2%), and psychiatrists (4.8%) prescribed two-thirds of the Gabapentinoids. Most (96.6%) of the Gabapentinoid visits did not have an approved indication for Gabapentinoids among the first three diagnoses. Among US ambulatory care visits from 2003 to 2016, Gabapentinoid use increased substantially, commonly prescribed by primary care physicians.