PharmacoEconomics & Outcomes News 699, p8 - 29 Mar 2014 Opioid use – multiple concerns Opioids are frequently prescribed for adolescents with headache, according to the results of a US study. 1 Using commercial claims data for 8373 adolescents aged 13–17 years with chronic headache, the study revealed that 46% received an opioid prescription, despite evidence, as the researchers point out, that opioids are inappropriate for the treatment of headache. Of the adolescents using opioids, 48% received one opioid prescription during the follow-up period, and 29% received ≥ 3 opioid prescriptions. The proportion of adolescents having an emergency-department (ED) visit for headache was significantly higher among adolescents who received opioids, compared with those who did not receive opioids (28% vs 14%). Logistic regression analysis showed that there was a strong association between ED visits with a headache diagnosis during follow-up and opioid use. Role in overdose deaths Another US study revealed that high-risk use of prescription opioids is frequent in Tennessee and is associated with increased overdose mortality. 2 Using data from the Tennessee Controlled Substances Monitoring Program, the study showed that opioid prescription rates increased by 32% over the 5-year study period (January 2007 through December 2011), from 108.3 to 142.5 per 100 population per year. In particular, there was a significant increase in high-risk use, with an increasing number of patients receiving opioids from ≥ 4 prescribers (from 5.8% during 2007 to 7.6% in 2011) or ≥ 4 pharmacies (from 2.0% to 2.5%), and an increasing number of patients receiving high opioid doses (from 1.7% to 2.8%). The study also showed that opioid-related overdose death was associated with high-risk use. Non-medical use A study that investigated the sources of prescription opioid pain relievers for non-medical use revealed that the majority (54%) obtained the agents from friends and relatives for free. 3 However, the study also showed that the source varied significantly by frequency of non- medical use. The group with the highest use (200–365 days in the past year) reported different sources (prescribed by ≥ 1 physician, 27%; given by a friend or relative for free, 26%; bought from a friend or relative, 23%; or bought from a drug dealer or other stranger, 15%). "These results underscore the need for interventions targeting prescribing behaviors, in addition to those targeting medication sharing, selling, and diversion," conclude the researchers. 1. DeVries A, et al. Opioid use among adolescent patients treated for headache. Journal of Adolescent Health : [6 pages], 7 Feb 2014. Available from: URL: http://www.jahonline.org/webfiles/images/journals/jah/feature.pdf. 2. Baumblatt JA, et al. High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths. JAMA Internal Medicine : [6 pages], 3 Mar 2014. Available from: URL: http://doi.org/10.1001/jamainternmed.2013.12711. 3. Jones CM, et al. Sources of Prescription Opioid Pain Relievers by Frequency of Past-Year Nonmedical Use: United States, 2008-2011. JAMA Internal Medicine : [2 pages], 3 Mar 2014. Available from: URL: http://doi.org/10.1001/ jamainternmed.2013.12809. 803100644 1 PharmacoEconomics & Outcomes News 29 Mar 2014 No. 699 1173-5503/14/0699-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved

Opioid use − multiple concerns

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PharmacoEconomics & Outcomes News 699, p8 - 29 Mar 2014

Opioid use – multiple concernsOpioids are frequently prescribed for adolescents

with headache, according to the results of a US study.1

Using commercial claims data for 8373 adolescentsaged 13–17 years with chronic headache, the studyrevealed that 46% received an opioid prescription,despite evidence, as the researchers point out, thatopioids are inappropriate for the treatment of headache.Of the adolescents using opioids, 48% received oneopioid prescription during the follow-up period, and29% received ≥ 3 opioid prescriptions. The proportion ofadolescents having an emergency-department (ED) visitfor headache was significantly higher amongadolescents who received opioids, compared with thosewho did not receive opioids (28% vs 14%). Logisticregression analysis showed that there was a strongassociation between ED visits with a headache diagnosisduring follow-up and opioid use.

Role in overdose deathsAnother US study revealed that high-risk use of

prescription opioids is frequent in Tennessee and isassociated with increased overdose mortality.2 Usingdata from the Tennessee Controlled SubstancesMonitoring Program, the study showed that opioidprescription rates increased by 32% over the 5-yearstudy period (January 2007 through December 2011),from 108.3 to 142.5 per 100 population per year. Inparticular, there was a significant increase in high-riskuse, with an increasing number of patients receivingopioids from ≥ 4 prescribers (from 5.8% during 2007 to7.6% in 2011) or ≥ 4 pharmacies (from 2.0% to 2.5%),and an increasing number of patients receiving highopioid doses (from 1.7% to 2.8%). The study alsoshowed that opioid-related overdose death wasassociated with high-risk use.

Non-medical useA study that investigated the sources of prescription

opioid pain relievers for non-medical use revealed thatthe majority (54%) obtained the agents from friends andrelatives for free.3 However, the study also showed thatthe source varied significantly by frequency of non-medical use. The group with the highest use(200–365 days in the past year) reported differentsources (prescribed by ≥ 1 physician, 27%; given by afriend or relative for free, 26%; bought from a friend orrelative, 23%; or bought from a drug dealer or otherstranger, 15%). "These results underscore the need forinterventions targeting prescribing behaviors, inaddition to those targeting medication sharing, selling,and diversion," conclude the researchers.1. DeVries A, et al. Opioid use among adolescent patients treated for headache.

Journal of Adolescent Health : [6 pages], 7 Feb 2014. Available from: URL:http://www.jahonline.org/webfiles/images/journals/jah/feature.pdf.

2. Baumblatt JA, et al. High-Risk Use by Patients Prescribed Opioids for Pain andIts Role in Overdose Deaths. JAMA Internal Medicine : [6 pages], 3 Mar 2014.Available from: URL: http://doi.org/10.1001/jamainternmed.2013.12711.

3. Jones CM, et al. Sources of Prescription Opioid Pain Relievers by Frequency ofPast-Year Nonmedical Use: United States, 2008-2011. JAMA Internal Medicine: [2 pages], 3 Mar 2014. Available from: URL: http://doi.org/10.1001/jamainternmed.2013.12809.

803100644