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Opioid therapy trajectories of patients with chronic non-cancer pain over one year of follow-up after initiating short-acting opioid formulations.

Acharya M, Hayes CJ, Li C, Painter JT, Dayer L, Martin BC. Opioid therapy trajectories of patients with chronic non-cancer pain over one year of follow-up after initiating short-acting opioid formulations. Pain medicine (Malden, Mass.). 2024 Jan 18; doi:10.1093/pm/pnad169.

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OBJECTIVE: This study compared opioid utilization trajectories of persons initiating tramadol, short-acting hydrocodone or short-acting oxycodone, and characterized opioid dose trajectories and type of opioid in persistent opioid therapy sub-samples. METHODS: A retrospective cohort study of adults with chronic non-cancer pain initiating opioid therapy was conducted using the IQVIA PharMetrics® Plus for Academics data (2008-2018). Continuous enrollment was required for 6 months before (baseline) and 12 months after (follow-up) the first opioid prescription (index date). Opioid therapy measures were assessed every 7 days over follow-up. Group-based trajectory modeling (GBTM) was used to identify trajectories for any opioid and total morphine milligram equivalent (MME) measures, and longitudinal latent class analysis (LLCC) was used for opioid therapy type. RESULTS: A total of 40,276 tramadol, 141,023 hydrocodone and 45,221 oxycodone initiators were included. GBTM on any opioid therapy identified three latent trajectories: Early discontinuers (tramadol-39.0%, hydrocodone-54.1%, oxycodone-61.4%), late discontinuers (tramadol-37.9%, hydrocodone-39.4%, oxycodone-33.3%), and persistent therapy (tramadol-6.7%, hydrocodone-6.5%, oxycodone-5.3%), and an additional fourth trajectory, intermittent therapy (tramadol-16.4%), was identified for tramadol initiators. There were 2,687, 9,169, and 2,377 individuals with persistent therapy for tramadol, hydrocodone and oxycodone respectively. GBTM on opioid dose resulted in six similar trajectory groups in each persistent therapy group. LLCC on opioid therapy type identified six latent classes for tramadol and oxycodone and seven classes for hydrocodone. CONCLUSION: Opioid therapy patterns meaningfully differed depending on the initial opioid prescribed, notably the presence of intermittent therapy among tramadol initiators, and higher MME and prescribing of long-acting opioids among oxycodone initiators.

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