Prescription opioid use is reported by approximately 5% of adults over 65. While much of this use follows standard prescribing guidelines, an unknown proportion leads to addiction and opioid abuse. The concerns recently raised in the media regarding Oxycontin and its frequent prescription for painful syndromes highlights the need for a careful evaluation of the rates and patterns of chronic opioid use and what proportion of that use is possibly problematic. Currently, little is known about the frequency of acute chronic opioid use in patients with chronic pain, and virtually nothing is known about or the patient and/or physician characteristics associated with chronic, potentially problematic, prescription opioid use. We propose to examine these issues in patients with arthritis. We will first determine the nature and frequency of chronic opioid use in two selected groups of patients with arthritis -- osteoarthritis and rheumatoid arthritis. Prescription opioid use will be examined in a community-based cohort of over 250,000 Medicare patients who receive prescription drug benefits through the State of Pennsylvania's Pharmaceutical Assistance Contract for the Elderly program. This cohort is typical in their demography and health care utilization, and represents an ideal group to study the patterns of chronic oploid use. Second, we will examine the rates and factors associated with potentially problematic chronic opioid use. Finally, we will determine the rates of opioid associated complications in this population. This research will be conducted in conjunction with the program Director of PACE, Thomas Snedden. He will actively participate in the research and will assure that our findings are integrated into opioid prescribing policy. Our goal is to use the results of the proposed research to inform a future intervention to improve opioid prescribing within this large pharmacy benefits program.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Social Sciences, Nursing, Epidemiology and Methods 4 (SNEM)
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Erinoff, Lynda
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Brigham and Women's Hospital
United States
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Solomon, Daniel H; Glynn, Robert J; Rothman, Kenneth J et al. (2008) Subgroup analyses to determine cardiovascular risk associated with nonsteroidal antiinflammatory drugs and coxibs in specific patient groups. Arthritis Rheum 59:1097-104
Solomon, Daniel H; Avorn, Jerry; Sturmer, Til et al. (2006) Cardiovascular outcomes in new users of coxibs and nonsteroidal antiinflammatory drugs: high-risk subgroups and time course of risk. Arthritis Rheum 54:1378-89
Solomon, Daniel H; Chibnik, Lori B; Losina, Elena et al. (2006) Development of a preliminary index that predicts adverse events after total knee replacement. Arthritis Rheum 54:1536-42
Sato, Masayo; Schneeweiss, Sebastian; Scranton, Richard et al. (2006) The validity of a rheumatoid arthritis medical records-based index of severity compared with the DAS28. Arthritis Res Ther 8:R57
Solomon, Daniel H; Avorn, Jerry; Wang, Philip S et al. (2006) Prescription opioid use among older adults with arthritis or low back pain. Arthritis Rheum 55:35-41
Hawker, Gillian A; Katz, Jeffrey N; Solomon, Daniel H (2006) The patient's perspective on the recall of Vioxx. J Rheumatol 33:1082-8
Solomon, D H; Finkelstein, J S; Polinski, J M et al. (2006) A randomized controlled trial of mailed osteoporosis education to older adults. Osteoporos Int 17:760-7
Fischer, Michael A; Cheng, Hailu; Schneeweiss, Sebastian et al. (2006) Prior authorization policies for selective cyclooxygenase-2 inhibitors in Medicaid: a policy review. Med Care 44:658-63
Morris, Charles A; Carrino, John A; Lang, Philipp et al. (2006) Incidental vertebral fractures on chest radiographs. Recognition, documentation, and treatment. J Gen Intern Med 21:352-6
Solomon, Daniel H; Goodson, Nicola J (2005) The cardiovascular system in rheumatic disease: the newest ""extraarticular"" manifestation? J Rheumatol 32:1415-7

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