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Opioid utilization patterns among patients with cancer and non-cancer pain

Catherine J. Datto, MD, MS, Yiqun Hu, MD, PhD, Eric Wittbrodt, PharmD, MPH, Perry G. Fine, MD

Abstract


Objective: Opioid pain medication continues to be an important treatment option for patients with moderate to severe cancer and non-cancer pain; however, limited evidence is available regarding differences in opioid use between these two populations. The objective of this analysis was to compare real-world opioid use patterns over time in these two populations.

Design: Retrospective analysis of administrative claims data.

Setting: HealthCore Integrated Research Environment database.

Patients: Adults with 1 opioid pharmacy claim (and a confirmed cancer diagnosis for the cancer pain cohort).

Main outcome measures: Opioid doses and dose changes following the initial prescribed (index) dose were determined.

Results: In the cancer pain (n = 9,209) and non-cancer pain (n = 409,703) cohorts, median index opioid doses were 51.7 and 45.0 morphine-equivalent units (MEU), respectively, and median post-index opioid doses were 55.8 and 45.1 MEU for the cancer pain and non-cancer pain cohorts, respectively. The most common dose escalation in both groups was up to a dose doubling (cancer pain, 31.8 percent; non-cancer pain, 28.3 percent). The proportions of patients with dose increases exceeding two times the index dose were low and clinically comparable between cohorts (cancer pain, 9.9 percent; non-cancer pain, 7.4 percent).

Conclusions: Opioid use was consistent between patients with cancer pain and non-cancer pain, including clinically comparable total daily opioid doses and consistent rates of dose escalations and chronic utilization. Opioid medications are an important element of cancer and non-cancer pain management; thus, access to appropriate therapies, use patterns, and risk assessment and management are important for both patient populations.


Keywords


opioid use, opioid dose, cancer pain, non-cancer pain

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References


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DOI: http://dx.doi.org/10.5055/jom.2019.0481

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