• Ann Emerg Med · Jun 2018

    Does Prescription Opioid Shopping Increase Overdose Rates in Medicaid Beneficiaries?

    • Benjamin C Sun, Nicoleta Lupulescu-Mann, Christina J Charlesworth, Hyunjee Kim, Daniel M Hartung, Richard A Deyo, and K John McConnell.
    • Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR. Electronic address: sunb@ohsu.edu.
    • Ann Emerg Med. 2018 Jun 1; 71 (6): 679687.e3679-687.e3.

    Study ObjectiveThe link between prescription opioid shopping and overdose events is poorly understood. We test the hypothesis that a history of prescription opioid shopping is associated with increased risk of overdose events.MethodsThis is a secondary analysis of a linked claims and controlled substance dispense database. We studied adult Medicaid beneficiaries in 2014 with prescription opioid use in the 6 months before an ambulatory care or emergency department visit with a pain-related diagnosis. The primary outcome was a nonfatal overdose event within 6 months of the cohort entry date. The exposure of interest (opioid shopping) was defined as having opioid prescriptions by different prescribers with greater than or equal to 1-day overlap and filled at 3 or more pharmacies in the 6 months before cohort entry. We used a propensity score to match shoppers with nonshoppers in a 1:1 ratio. We calculated the absolute difference in outcome rates between shoppers and nonshoppers.ResultsWe studied 66,328 patients, including 2,571 opioid shoppers (3.9%). There were 290 patients (0.4%) in the overall cohort who experienced a nonfatal overdose. In unadjusted analyses, shoppers had higher event rates than nonshoppers (rate difference of 4.4 events per 1,000; 95% confidence interval 0.8 to 7.9). After propensity score matching, there were no outcome differences between shoppers and nonshoppers (rate difference of 0.4 events per 1,000; 95% confidence interval -4.7 to 5.5). These findings were robust to various definitions of opioid shoppers and look-back periods.ConclusionPrescription opioid shopping is not independently associated with increased risk of overdose events.Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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