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.
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