Journal Article

Characteristics of opioid prescribing to outpatients with chronic liver diseases: A call for action

Agbalajobi, Olufunso M., Gellad, Walid F., Zhang, Grace, Gmelin, Theresa, Moon, Andrew M., Jonassaint, Naudia, Alexandre, Wheytnie, Rogal, Shari S.

2021

Overview

Chronic liver disease (CLD) is among the strongest risk factors for adverse prescription opioid-related events. Yet, the current prevalence and factors associated with high-risk opioid prescribing in patients with chronic liver disease (CLD) remain unclear, making it challenging to address opioid safety in this population. Therefore, we aimed to characterize opioid prescribing patterns among patients with CLD. This retrospective cohort study included patients with CLD identified at a single medical center and followed for one year from 10/1/2015-9/30/2016. Multivariable, multinomial regression was used identify the patient characteristics, including demographics, medical conditions, and liver-related factors, that were associated with opioid prescriptions and high-risk prescriptions (≥90mg morphine equivalents per day [MME/day] or co-prescribed with benzodiazepines). Nearly half (47%) of 12,425 patients with CLD were prescribed opioids over a one-year period, with 17% of these receiving high-risk prescriptions. The baseline factors significantly associated with high-risk opioid prescriptions included female gender (adjusted incident rate ratio, AIRR = 1.32, 95% CI = 1.14-1.53), Medicaid insurance (AIRR = 1.68, 95% CI = 1.36-2.06), cirrhosis (AIRR = 1.22, 95% CI = 1.04-1.43) and baseline chronic pain (AIRR = 3.40, 95% CI = 2.94-4.01), depression (AIRR = 1.93, 95% CI = 1.60-2.32), anxiety (AIRR = 1.84, 95% CI = 1.53-2.22), substance use disorder (AIRR = 2.16, 95% CI = 1.67-2.79), and Charlson comorbidity score (AIRR = 1.27, 95% CI = 1.22-1.32). Non-alcoholic fatty liver disease was associated with decreased high-risk opioid prescriptions (AIRR = 0.56, 95% CI = 0.47-0.66). Opioid medications continue to be prescribed to nearly half of patients with CLD, despite efforts to curtail opioid prescribing due to known adverse events in this population.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Ambulatory medical care / Analgesics, Opioid - administration & dosage / Benzodiazepines / Chronic pain / Chronic Pain - drug therapy / Chronic Pain - epidemiology / Chronic Pain - etiology / Chronic Pain - pathology / Cirrhosis / Demographic aspects / Demographics / Demography / Dosage and administration / Drug dosages / Drug Prescriptions - standards / Drug therapy / Ethnicity / Etiology / Fatty liver / Female / Gastroenterology / Government programs / Health care facilities / Health risks / Hepatitis / Hepatology / Hispanic people / Humans / Internal medicine / Liver / Liver cirrhosis / Liver diseases / Liver Diseases - complications / Male / Medicaid / Medicine / Medicine and Health Sciences / Methods / Middle Aged / Morphine / Narcotics / Opioid-Related Disorders - prevention & control / Opioids / Outpatients - statistics & numerical data / Pain / Patients / Population / Practice Patterns, Physicians' - standards / Prescriptions / Retrospective Studies / Risk analysis / Risk factors / Substance use / United States - epidemiology