• J Opioid Manag · Sep 2017

    Opioid tolerance and urine drug testing among initiates of extended-release or long-acting opioids in Food and Drug Administration's Sentinel System.

    • Marc R Larochelle, Noelle M Cocoros, Jennifer Popovic, Elizabeth C Dee, Cynthia Kornegay, Jing Ju, and Judith A Racoosin.
    • Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Section of General Internal Medicine, Boston, Massachusetts.
    • J Opioid Manag. 2017 Sep 1; 13 (5): 315-327.

    ObjectiveA risk evaluation and mitigation strategy for extended-release and long-acting (ER/LA) opioid analgesics was approved by the Food and Drug Administration in 2012. Our objective was to assess frequency of opioid tolerance and urine drug testing for individuals initiating ER/LA opioid analgesics.DesignRetrospective cohort study.SettingSentinel, a distributed database with electronic healthcare data on >190 million predominantly commercially insured members.Patients, ParticipantsMembers under age 65 initiating ER/LA opioid analgesics between January 2009 and December 2013.Main Outcome Measure(S)We examined the proportion of opioid-tolerant-only ER/LA opioid analgesic initiates meeting tolerance criteria: receipt of ≥30 mg oxycodone equivalents per day in 7 days prior to the first opioid-tolerant-only dispensing. We separately examined the proportion of new users of extended-release oxycodone (ERO) and other ER/LA opioid analgesics with a claim for a urine drug test in the 30 days prior to, and separately for the 183 days after, dispensing.ResultsWe identified 79,824 ERO, 7,343 extended-release hydromorphone, and 91,778 transdermal fentanyl opi-oid-tolerant-only episodes. Tolerance criteria were met in 64 percent of ERO, 64 percent of extended-release hydromorphone and 40 percent of transdermal fentanyl episodes. We identified 210,581 incident ERO and 311,660 other ER/LA opioid analgesic episodes. Use of urine drug testing for ERO compared with other ER/LA opioid analgesics was: 4 percent vs 14 percent respectively in the 30 days prior to initiation and 9 percent vs 23 percent respectively in the 183 days following initiation.ConclusionsThese results suggest potential areas for improving appropriate ER/LA opioid analgesic prescribing practices.

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