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Opioid-related overdose and chronic use following an initial prescription of hydrocodone versus oxycodone
BACKGROUND: Hydrocodone and oxycodone are prescribed commonly to treat pain. However, differences in risk of opioid-related adverse outcomes after an initial prescription are unknown. This study aims to determine the risk of opioid-related adverse events, defined as either chronic use or opioid over...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8982846/ https://www.ncbi.nlm.nih.gov/pubmed/35381052 http://dx.doi.org/10.1371/journal.pone.0266561 |
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author | Weiner, Scott G. Hendricks, Michelle A. El Ibrahimi, Sanae Ritter, Grant A. Hallvik, Sara E. Hildebran, Christi Weiss, Roger D. Boyer, Edward W. Flores, Diana P. Nelson, Lewis S. Kreiner, Peter W. Fischer, Michael A. |
author_facet | Weiner, Scott G. Hendricks, Michelle A. El Ibrahimi, Sanae Ritter, Grant A. Hallvik, Sara E. Hildebran, Christi Weiss, Roger D. Boyer, Edward W. Flores, Diana P. Nelson, Lewis S. Kreiner, Peter W. Fischer, Michael A. |
author_sort | Weiner, Scott G. |
collection | PubMed |
description | BACKGROUND: Hydrocodone and oxycodone are prescribed commonly to treat pain. However, differences in risk of opioid-related adverse outcomes after an initial prescription are unknown. This study aims to determine the risk of opioid-related adverse events, defined as either chronic use or opioid overdose, following a first prescription of hydrocodone or oxycodone to opioid naïve patients. METHODS: A retrospective analysis of multiple linked public health datasets in the state of Oregon. Adult patients ages 18 and older who a) received an initial prescription for oxycodone or hydrocodone between 2015–2017 and b) had no opioid prescriptions or opioid-related hospitalizations or emergency department visits in the year preceding the prescription were followed through the end of 2018. First-year chronic opioid use was defined as ≥6 opioid prescriptions (including index) and average ≤30 days uncovered between prescriptions. Fatal or non-fatal opioid overdose was indicated from insurance claims, hospital discharge data or vital records. RESULTS: After index prescription, 2.8% (n = 14,458) of individuals developed chronic use and 0.3% (n = 1,480) experienced overdose. After adjustment for patient and index prescription characteristics, patients receiving oxycodone had lower odds of developing chronic use relative to patients receiving hydrocodone (adjusted odds ratio = 0.95, 95% confidence interval (CI) 0.91–1.00) but a higher risk of overdose (adjusted hazard ratio (aHR) = 1.65, 95% CI 1.45–1.87). Oxycodone monotherapy appears to greatly increase the hazard of opioid overdose (aHR 2.18, 95% CI 1.86–2.57) compared with hydrocodone with acetaminophen. Oxycodone combined with acetaminophen also shows a significant increase (aHR 1.26, 95% CI 1.06–1.50), but not to the same extent. CONCLUSIONS: Among previously opioid-naïve patients, the risk of developing chronic use was slightly higher with hydrocodone, whereas the risk of overdose was higher after oxycodone, in combination with acetaminophen or monotherapy. With a goal of reducing overdose-related deaths, hydrocodone may be the favorable agent. |
format | Online Article Text |
id | pubmed-8982846 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-89828462022-04-06 Opioid-related overdose and chronic use following an initial prescription of hydrocodone versus oxycodone Weiner, Scott G. Hendricks, Michelle A. El Ibrahimi, Sanae Ritter, Grant A. Hallvik, Sara E. Hildebran, Christi Weiss, Roger D. Boyer, Edward W. Flores, Diana P. Nelson, Lewis S. Kreiner, Peter W. Fischer, Michael A. PLoS One Research Article BACKGROUND: Hydrocodone and oxycodone are prescribed commonly to treat pain. However, differences in risk of opioid-related adverse outcomes after an initial prescription are unknown. This study aims to determine the risk of opioid-related adverse events, defined as either chronic use or opioid overdose, following a first prescription of hydrocodone or oxycodone to opioid naïve patients. METHODS: A retrospective analysis of multiple linked public health datasets in the state of Oregon. Adult patients ages 18 and older who a) received an initial prescription for oxycodone or hydrocodone between 2015–2017 and b) had no opioid prescriptions or opioid-related hospitalizations or emergency department visits in the year preceding the prescription were followed through the end of 2018. First-year chronic opioid use was defined as ≥6 opioid prescriptions (including index) and average ≤30 days uncovered between prescriptions. Fatal or non-fatal opioid overdose was indicated from insurance claims, hospital discharge data or vital records. RESULTS: After index prescription, 2.8% (n = 14,458) of individuals developed chronic use and 0.3% (n = 1,480) experienced overdose. After adjustment for patient and index prescription characteristics, patients receiving oxycodone had lower odds of developing chronic use relative to patients receiving hydrocodone (adjusted odds ratio = 0.95, 95% confidence interval (CI) 0.91–1.00) but a higher risk of overdose (adjusted hazard ratio (aHR) = 1.65, 95% CI 1.45–1.87). Oxycodone monotherapy appears to greatly increase the hazard of opioid overdose (aHR 2.18, 95% CI 1.86–2.57) compared with hydrocodone with acetaminophen. Oxycodone combined with acetaminophen also shows a significant increase (aHR 1.26, 95% CI 1.06–1.50), but not to the same extent. CONCLUSIONS: Among previously opioid-naïve patients, the risk of developing chronic use was slightly higher with hydrocodone, whereas the risk of overdose was higher after oxycodone, in combination with acetaminophen or monotherapy. With a goal of reducing overdose-related deaths, hydrocodone may be the favorable agent. Public Library of Science 2022-04-05 /pmc/articles/PMC8982846/ /pubmed/35381052 http://dx.doi.org/10.1371/journal.pone.0266561 Text en © 2022 Weiner et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Weiner, Scott G. Hendricks, Michelle A. El Ibrahimi, Sanae Ritter, Grant A. Hallvik, Sara E. Hildebran, Christi Weiss, Roger D. Boyer, Edward W. Flores, Diana P. Nelson, Lewis S. Kreiner, Peter W. Fischer, Michael A. Opioid-related overdose and chronic use following an initial prescription of hydrocodone versus oxycodone |
title | Opioid-related overdose and chronic use following an initial prescription of hydrocodone versus oxycodone |
title_full | Opioid-related overdose and chronic use following an initial prescription of hydrocodone versus oxycodone |
title_fullStr | Opioid-related overdose and chronic use following an initial prescription of hydrocodone versus oxycodone |
title_full_unstemmed | Opioid-related overdose and chronic use following an initial prescription of hydrocodone versus oxycodone |
title_short | Opioid-related overdose and chronic use following an initial prescription of hydrocodone versus oxycodone |
title_sort | opioid-related overdose and chronic use following an initial prescription of hydrocodone versus oxycodone |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8982846/ https://www.ncbi.nlm.nih.gov/pubmed/35381052 http://dx.doi.org/10.1371/journal.pone.0266561 |
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