The most pervasive chronic condition, chronic non-cancer pain (CNCP), is prevalent in up to nearly 40% of working-aged older adults. Despite lack of robust evidence regarding the efficacy and effectiveness of opioids for CNCP, and currently-available effective non-opioid treatments, many patients still receive opioid therapy. Older adults are more likely to use prescription opioids than middle aged adults, and many adults with CNCP who were initiated on opioids acutely, transition into chronic opioid therapy (COT) with adverse health consequences. Our previous research has shown this transition, with the associated adverse health consequences, can be predicted using a set of modifiable factors including opioid regimen characteristics. Adding co-prescribed benzodiazepines to the opioid regimen can further increase these risks. Also, the labor force is aging and 40% of adults 55 years and older are working or looking for work. Health related factors of working-age older adults can burden both the employer and employee beyond the direct medical costs associated with treating a condition. The purpose of this proposal is to quantify the productivity losses associated with a transition to COT, with or without concurrent benzodiazepine therapy, among a growing segment of the US workforce, working-aged older adults. A retrospective cohort design based on Truven Health MarketScan Commercial Claims and Encounters Database linked with Heath and Productivity Management (HPM) data will be used to (1) identify leading predictors of transitioning from acute to COT among working-aged older adults (ages 50?64) without cancer, (2) evaluate the productivity losses associated with transitioning from acute to COT in working-aged older adults without cancer, and (3) evaluate the productivity losses associated with co-prescribing of a benzodiazepine to COT in working-aged older adults without cancer. By providing estimates for losses in productivity associated with COT, stakeholders including patients, health care providers, health care payers, and employers can better quantify the value of maintaining a healthy workforce and justify increased spending on early risk mitigation efforts. With this research we strive to reduce the impact of prescription drug misuse burden in working-age older Americans through evaluation of safe and effective use of medications, particularly opioids.
Nearly three decades ago, the medical community was assured that opioid pain medications had limited addiction potential. In 2016, more than 115 Americans died of an opioid overdose every day. Although many Americans take opioids chronically without misusing or abusing them, an effective chronic opioid therapy regimen to treat chronic non-cancer pain has not been identified. This project will estimate the indirect costs, in terms of loss of workplace productivity, of transitioning to chronic opioid therapy and help build the financial justification for establishing early risk mitigation efforts with new opioid prescriptions.