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Daniels B, Luckett T, Liauw W, Falster MO, Gisev N, Blyth FM, Pearson SA. Trajectories of Opioid Use Before and After Cancer Diagnosis: A Population-Based Cohort Study. J Pain Symptom Manage 2024:S0885-3924(24)00809-1. [PMID: 38878910 DOI: 10.1016/j.jpainsymman.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/27/2024] [Accepted: 06/09/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Opioid use prior to cancer diagnosis increases the likelihood of long-term use during survivorship, however, patterns of use before and after diagnosis are not understood. METHODS We used population-based dispensing data linked with cancer and death notifications to identify two cohorts of adults residing in New South Wales initiating opioids within 24 months prior to a first cancer diagnosed between 2014 and 2016: 'survivors' (alive 24 months following diagnosis) and 'decedents' (died within 24 months). We used group-based trajectory modelling to identify trajectories of monthly opioid dispensings and dispensed oral morphine equivalent milligrams (OMEmg) during the 24 months before/after cancer diagnosis. RESULTS There were 21,843 survivors with four prediagnosis opioid dispensing trajectories: infrequent (58% of the cohort), late increasing (26%), moderate (10%), and sustained dispensing (6%). We observed an overall increase in dispensed OMEmg of 83 OMEmg (95% CI: 76-91) during the month of diagnosis, with strong opioid formulations comprising most treatment postdiagnosis. Within each prediagnosis opioid trajectory group, we observed five to six postdiagnosis trajectory groups, including no opioid dispensing. Moderate and sustained prediagnosis groups had large proportions of people continuing or increasing opioid dispensing after diagnosis, while small proportions discontinued opioid treatment. We observed similar trajectories in the decedent cohort. CONCLUSIONS There is considerable heterogeneity in opioid use before and after cancer diagnosis. Our findings suggest noncancer factors drive a significant proportion of postdiagnosis opioid use, but use increased significantly from the month of cancer diagnosis and never returned to prediagnosis levels.
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Affiliation(s)
- Benjamin Daniels
- Medicines Intelligence Research Program, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Winston Liauw
- South Eastern Sydney Local Health District Cancer Services and University of New South Wales Medicine Medicine, Sydney, New South Wales, Australia
| | - Michael O Falster
- Medicines Intelligence Research Program, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Medicines Intelligence Research Program, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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Axson SA, Becker WC, Merlin JS, Lorenz KA, Midboe AM, C Black A. Long-term opioid therapy trajectories in veteran patients with and without substance use disorder. Addict Behav 2024; 153:107997. [PMID: 38442438 PMCID: PMC11080947 DOI: 10.1016/j.addbeh.2024.107997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/16/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Sydney A Axson
- Health Services Research & Development, VA Connecticut Healthcare System, West Haven, CT, USA; The National Clinician Scholars Program, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA; Ross and Carol Nese College of Nursing, The Pennsylvania State University, 201 Nursing Sciences Building, University Park, PA 16802, USA.
| | - William C Becker
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA; Pain Research, Informatics, Multimorbidities and Education Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Jessica S Merlin
- CHAllenges in Managing and Preventing Pain (CHAMPP) Clinical Research Center, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Karl A Lorenz
- Stanford University School of Medicine, Stanford, CA, USA.
| | - Amanda M Midboe
- Stanford University School of Medicine, Stanford, CA, USA; Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA, USA.
| | - Anne C Black
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA; Pain Research, Informatics, Multimorbidities and Education Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, USA.
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3
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Gisev N, Buizen L, Hopkins RE, Schaffer AL, Daniels B, Bharat C, Dobbins T, Larney S, Blyth F, Currow DC, Wilson A, Pearson SA, Degenhardt L. Five-Year Trajectories of Prescription Opioid Use. JAMA Netw Open 2023; 6:e2328159. [PMID: 37561463 PMCID: PMC10415961 DOI: 10.1001/jamanetworkopen.2023.28159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/25/2023] [Indexed: 08/11/2023] Open
Abstract
Importance There are known risks of using opioids for extended periods. However, less is known about the long-term trajectories of opioid use following initiation. Objective To identify 5-year trajectories of prescription opioid use, and to examine the characteristics of each trajectory group. Design, Setting, and Participants This population-based cohort study conducted in New South Wales, Australia, linked national pharmaceutical claims data to 10 national and state data sets to determine sociodemographic characteristics, clinical characteristics, drug use, and health services use. The cohort included adult residents (aged ≥18 years) of New South Wales who initiated a prescription opioid between July 1, 2003, and December 31, 2018. Statistical analyses were conducted from February to September 2022. Exposure Dispensing of a prescription opioid, with no evidence of opioid dispensing in the preceding 365 days, identified from pharmaceutical claims data. Main Outcomes and Measures The main outcome was the trajectories of monthly opioid use over 60 months from opioid initiation. Group-based trajectory modeling was used to classify these trajectories. Linked health care data sets were used to examine characteristics of individuals in different trajectory groups. Results Among 3 474 490 individuals who initiated a prescription opioid (1 831 230 females [52.7%]; mean [SD] age, 49.7 [19.3] years), 5 trajectories of long-term opioid use were identified: very low use (75.4%), low use (16.6%), moderate decreasing to low use (2.6%), low increasing to moderate use (2.6%), and sustained use (2.8%). Compared with individuals in the very low use trajectory group, those in the sustained use trajectory group were older (age ≥65 years: 22.0% vs 58.4%); had more comorbidities, including cancer (4.1% vs 22.2%); had increased health services contact, including hospital admissions (36.9% vs 51.6%); had higher use of psychotropic (16.4% vs 42.4%) and other analgesic drugs (22.9% vs 47.3%) prior to opioid initiation, and were initiated on stronger opioids (20.0% vs 50.2%). Conclusions and relevance Results of this cohort study suggest that most individuals commencing treatment with prescription opioids had relatively low and time-limited exposure to opioids over a 5-year period. The small proportion of individuals with sustained or increasing use was older with more comorbidities and use of psychotropic and other analgesic drugs, likely reflecting a higher prevalence of pain and treatment needs in these individuals.
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Affiliation(s)
- Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Luke Buizen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ria E. Hopkins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrea L. Schaffer
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Benjamin Daniels
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Timothy Dobbins
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sarah Larney
- Department of Family Medicine and Emergency Medicine and Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Fiona Blyth
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David C. Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
- Menzies Centre for Health Policy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
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Merlin JS, Black AC, Midboe AM, Troszak L, Asch SM, Bohnert A, Fenton BT, Giannitrapani KF, Glassman P, Kerns RD, Silveira M, Lorenz KA, Abel EA, Becker WC. Long-term opioid therapy trajectories and overdose in patients with and without cancer. BMJ ONCOLOGY 2023; 2:e000023. [PMID: 38259328 PMCID: PMC10802123 DOI: 10.1136/bmjonc-2022-000023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Objective Pain is experienced by most patients with cancer and opioids are a cornerstone of management. Our objectives were (1) to identify patterns or trajectories of long-term opioid therapy (LTOT) and their correlates among patients with and without cancer and (2) to assess the association between trajectories and risk for opioid overdose, considering the potential moderating role of cancer. Methods and Analysis We conducted a retrospective cohort study among individuals in the US Veterans Health Administration (VHA) database with incident LTOT with and without cancer (N=44,351; N=285,772, respectively) between 2010-2017. We investigated the relationship between LTOT trajectory and all International Classification of Diseases-9 and 10-defined accidental and intentional opioid-related overdoses. Results Trajectories of opioid receipt observed in patients without cancer and replicated in patients with cancer were: low-dose/stable trend, low-dose/de-escalating trend, moderate-dose/stable trend, moderate-dose/escalating with quadratic downturn trend, and high-dose/escalating with quadratic downturn trend. Time to first overdose was significantly predicted by higher-dose and escalating trajectories; the two low-dose trajectories conferred similar, lower risk. Conditional hazard ratios (99% CI) for the moderate-dose, moderate-dose/escalating with quadratic downturn and high-dose/escalating with quadratic downturn trends were 1·84 (1·18, 2·85), 2·56 (1·54, 4·25), and 2·41 (1·37, 4·26), respectively. Effects of trajectories on time to overdose did not differ by presence of cancer; inferences were replicated when restricting to patients with stage 3/4 cancer. Conclusion Patients with cancer face opioid overdose risks like patients without cancer. Future studies should seek to expand and address our knowledge about opioid risk in cancer patients. Trial registration None.
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Affiliation(s)
- Jessica S Merlin
- CHAllenges on Managing and Preventing Pain (CHAMPP) Clinical Research Center, University of Pittsburgh, Pittsburgh, PA, USA
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anne C Black
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Health Services Research & Development, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Amanda M Midboe
- VA Palo Alto Healthcare System, Center for Innovation to Implementation, Palo Alto, CA
- Department of Medicine/Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lara Troszak
- VA Palo Alto Healthcare System, Center for Innovation to Implementation, Palo Alto, CA
| | - Steven M Asch
- VA Palo Alto Healthcare System, Center for Innovation to Implementation, Palo Alto, CA
- Department of Medicine/Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Amy Bohnert
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Brenda T Fenton
- Health Services Research & Development, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Karleen F Giannitrapani
- VA Palo Alto Healthcare System, Center for Innovation to Implementation, Palo Alto, CA
- Department of Medicine/Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Peter Glassman
- VA Center for Medication Safety, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Pharmacy Benefits Management Services, Department of Veterans Affairs, Washington, DC, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Robert D Kerns
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Health Services Research & Development, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Maria Silveira
- Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Palliative Care, Lieutenant Colonel Charles S. Kettles VA Medical Center, Ann Arbor MI, USA
| | - Karl A Lorenz
- VA Palo Alto Healthcare System, Center for Innovation to Implementation, Palo Alto, CA
- Department of Medicine/Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Erica A Abel
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Health Services Research & Development, VA Connecticut Healthcare System, West Haven, CT, USA
| | - William C Becker
- Health Services Research & Development, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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5
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Williams JR, Alam IZ, Ranapurwala SI. Trajectories and correlates of opioid prescription receipt among patients experiencing interpersonal violence. PLoS One 2022; 17:e0273846. [PMID: 36083884 PMCID: PMC9462725 DOI: 10.1371/journal.pone.0273846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Interpersonal violence increases vulnerability to the deleterious effects of opioid use. Increased opioid prescription receipt is a major contributor to the opioid crisis; however, our understanding of prescription patterns and risk factors among those with a history of interpersonal violence remains elusive. This study sought to identify 5-year longitudinal patterns of opioid prescription receipt among patients experiencing interpersonal violence within a large healthcare system and sociodemographic and clinical characteristics associated with prescription patterns. This secondary analysis examined electronic health record data from January 2004–August 2019 for a cohort of patients (N = 1,587) referred for interpersonal violence services. Latent class growth analysis was used to estimate trajectories of opioid prescription receipt over a 5-year period. Standardized differences were calculated to assess variation in sociodemographic and clinical characteristics between classes. Our cohort had a high prevalence of prescription opioid receipt (73.3%) and underlying co-morbidities, including chronic pain (54.6%), substance use disorders (39.0%), and mental health diagnoses (76.9%). Six prescription opioid receipt classes emerged, characterized by probability of any prescription opioid receipt at the start and end of the study period (high, medium, low, never) and change in probability over time (increasing, decreasing, stable). Classes with the highest probability of prescription opioids also had the highest proportions of males, chronic pain diagnoses, substance use disorders, and mental health diagnoses. Black, non-Hispanic and Hispanic patients were more likely to be in low or no prescription opioid receipt classes. These findings highlight the importance of monitoring for synergistic co-morbidities when providing pain management and offering treatment that is trauma-informed, destigmatizing, and integrated into routine care.
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Affiliation(s)
- Jessica R. Williams
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Ishrat Z. Alam
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Shabbar I. Ranapurwala
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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6
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Jennings MV, Lee H, Rocha DB, Bianchi SB, Coombes BJ, Crist RC, Faucon AB, Hu Y, Kember RL, Mallard TT, Niarchou M, Poulsen MN, Straub P, Urman RD, Walsh CG, Davis LK, Smoller JW, Troiani V, Sanchez-Roige S. Identifying High-Risk Comorbidities Associated with Opioid Use Patterns Using Electronic Health Record Prescription Data. Complex Psychiatry 2022; 8:47-55. [PMID: 36545045 PMCID: PMC9669950 DOI: 10.1159/000525313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/23/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Opioid use disorders (OUDs) constitute a major public health issue, and we urgently need alternative methods for characterizing risk for OUD. Electronic health records (EHRs) are useful tools for understanding complex medical phenotypes but have been underutilized for OUD because of challenges related to underdiagnosis, binary diagnostic frameworks, and minimally characterized reference groups. As a first step in addressing these challenges, a new paradigm is warranted that characterizes risk for opioid prescription misuse on a continuous scale of severity, i.e., as a continuum. Methods Across sites within the PsycheMERGE network, we extracted prescription opioid data and diagnoses that co-occur with OUD (including psychiatric and substance use disorders, pain-related diagnoses, HIV, and hepatitis C) for over 2.6 million patients across three health registries (Vanderbilt University Medical Center, Mass General Brigham, Geisinger) between 2005 and 2018. We defined three groups based on levels of opioid exposure: no prescriptions, minimal exposure, and chronic exposure and then compared the comorbidity profiles of these groups to the full registries and to those with OUD diagnostic codes. Results Our results confirm that EHR data reflects known higher prevalence of substance use disorders, psychiatric disorders, medical, and pain diagnoses in patients with OUD diagnoses and chronic opioid use. Comorbidity profiles that distinguish opioid exposure are strikingly consistent across large health systems, indicating the phenotypes described in this new quantitative framework are robust to health systems differences. Conclusion This work indicates that EHR prescription opioid data can serve as a platform to characterize complex risk markers for OUD using existing data.
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Affiliation(s)
- Mariela V Jennings
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Hyunjoon Lee
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel B Rocha
- Phenomic Analytics and Clinical Data Core, Geisinger, Danville, Pennsylvania, USA
| | - Sevim B Bianchi
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Brandon J Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard C Crist
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Annika B Faucon
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Rachel L Kember
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Travis T Mallard
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria Niarchou
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa N Poulsen
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Peter Straub
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Colin G Walsh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lea K Davis
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vanessa Troiani
- Geisinger Clinic, Geisinger, Danville, Pennsylvania, USA.,Department of Imaging Science and Innovation, Geisinger, Danville, Pennsylvania, USA.,Neuroscience Institute, Geisinger, Danville, Pennsylvania, USA.,Department of Basic Sciences, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Sandra Sanchez-Roige
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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7
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Troiani V, Crist RC, Doyle GA, Ferraro TN, Beiler D, Ranck S, McBryan K, Jarvis MA, Barbour JS, Han JJ, Ness RJ, Berrettini WH, Robishaw JD. Genetics and prescription opioid use (GaPO): study design for consenting a cohort from an existing biobank to identify clinical and genetic factors influencing prescription opioid use and abuse. BMC Med Genomics 2021; 14:253. [PMID: 34702274 PMCID: PMC8547564 DOI: 10.1186/s12920-021-01100-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/15/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Prescription opioids (POs) are commonly used to treat moderate to severe chronic pain in the health system setting. Although they improve quality of life for many patients, more work is needed to identify both the clinical and genetic factors that put certain individuals at high risk for developing opioid use disorder (OUD) following use of POs for pain relief. With a greater understanding of important risk factors, physicians will be better able to identify patients at highest risk for developing OUD for whom non-opioid alternative therapies and treatments should be considered. METHODS We are conducting a prospective observational study that aims to identify the clinical and genetic factors most stongly associated with OUD. The study design leverages an existing biobank that includes whole exome sequencing and array genotyping. The biobank is maintained within an integrated health system, allowing for the large-scale capture and integration of genetic and non-genetic data. Participants are enrolled into the health system biobank via informed consent and then into a second study that focuses on opioid medication use. Data capture includes validated self-report surveys measuring addiction severity, depression, anxiety, and nicotine use, as well as additional clinical, prescription, and brain imaging data extracted from electronic health records. DISCUSSION We will harness this multimodal data capture to establish meaningful patient phenotypes in order to understand the genetic and non-genetic contributions to OUD.
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Affiliation(s)
- Vanessa Troiani
- Geisinger Clinic, Geisinger, Danville, PA, USA.
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.
- Neuroscience Institute, Geisinger, Danville, PA, USA.
- Department of Basic Sciences, Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
| | - Richard C Crist
- Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Glenn A Doyle
- Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas N Ferraro
- Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | | | | | | | - John J Han
- Department of Pain Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Ryan J Ness
- Department of Pain Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Wade H Berrettini
- Geisinger Clinic, Geisinger, Danville, PA, USA
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Janet D Robishaw
- Department of Biomedical Science, Schmidt College of Medicine of Florida Atlantic University, Boca Raton, FL, USA
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8
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Freiberg MS, Duncan MS, Alcorn C, Chang CH, Kundu S, Mumpuni A, Smith EK, Loch S, Bedigian A, Vittinghoff E, So‐Armah K, Hsue PY, Justice AC, Tseng ZH. HIV Infection and the Risk of World Health Organization-Defined Sudden Cardiac Death. J Am Heart Assoc 2021; 10:e021268. [PMID: 34493058 PMCID: PMC8649505 DOI: 10.1161/jaha.121.021268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/09/2021] [Indexed: 12/04/2022]
Abstract
Background People living with HIV have higher sudden cardiac death (SCD) rates compared with the general population. Whether HIV infection is an independent SCD risk factor is unclear. Methods and Results This study evaluated participants from the Veterans Aging Cohort Study, an observational, longitudinal cohort of veterans with and without HIV infection matched 1:2 on age, sex, race/ethnicity, and clinical site. Baseline for this study was a participant's first clinical visit on or after April 1, 2003. Participants were followed through December 31, 2014. Using Cox proportional hazards regression, we assessed whether HIV infection, CD4 cell counts, and/or HIV viral load were associated with World Health Organization (WHO)-defined SCD risk. Among 144 336 participants (30% people living with HIV), the mean (SD) baseline age was 50.0 years (10.6 years), 97% were men, and 47% were of Black race. During follow-up (median, 9.0 years), 3035 SCDs occurred. HIV infection was associated with increased SCD risk (hazard ratio [HR], 1.14; 95% CI, 1.04-1.25), adjusting for possible confounders. In analyses with time-varying CD4 and HIV viral load, people living with HIV with CD4 counts <200 cells/mm3 (HR, 1.57; 95% CI, 1.28-1.92) or viral load >500 copies/mL (HR, 1.70; 95% CI, 1.46-1.98) had increased SCD risk versus veterans without HIV. In contrast, people living with HIV who had CD4 cell counts >500 cells/mm3 (HR, 1.03; 95% CI, 0.90-1.18) or HIV viral load <500 copies/mL (HR, 0.97; 95% CI, 0.87-1.09) were not at increased SCD risk. Conclusions HIV infection is associated with increased risk of WHO-defined SCD among those with elevated HIV viral load or low CD4 cell counts.
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Affiliation(s)
- Matthew S. Freiberg
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
- Geriatric Research Education and Clinical Centers (GRECC)Veterans Affairs Tennessee Valley Healthcare SystemNashvilleTN
- Department of MedicineVanderbilt University Medical CenterNashvilleTN
- Yale School of Public HealthNew HavenCT
| | - Meredith S. Duncan
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
- Department of BiostatisticsUniversity of KentuckyLexingtonKY
| | - Charles Alcorn
- Department of BiostatisticsGraduate School of Public HealthUniversity of PittsburghPA
| | - Chung‐Chou H. Chang
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Suman Kundu
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
| | - Asri Mumpuni
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
- Vanderbilt Institute for Clinical and Translational ResearchVanderbilt University Medical CenterNashvilleTN
| | - Emily K. Smith
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
| | - Sarah Loch
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
- Vanderbilt Center for Child Health PolicyVanderbilt University Medical CenterNashvilleTN
| | | | - Eric Vittinghoff
- Department of Epidemiology and BiostatisticsUniversity of California at San FranciscoCA
| | - Kaku So‐Armah
- Division of General Internal MedicineBoston UniversityBostonMA
| | - Priscilla Y. Hsue
- Division of CardiologyUniversity of California San FranciscoSan FranciscoCA
| | - Amy C. Justice
- Veterans Affairs Connecticut Health Care SystemWest Haven Veterans Administration Medical CenterWest HavenCT
- Department of MedicineYale School of MedicineNew HavenCT
| | - Zian H. Tseng
- Cardiac Electrophysiology Section, Division of CardiologyUniversity of California San FranciscoSan FranciscoCA
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Abstract
This paper is the forty-second consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2019 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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10
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Zhou H, Rentsch CT, Cheng Z, Kember RL, Nunez YZ, Sherva RM, Tate JP, Dao C, Xu K, Polimanti R, Farrer LA, Justice AC, Kranzler HR, Gelernter J. Association of OPRM1 Functional Coding Variant With Opioid Use Disorder: A Genome-Wide Association Study. JAMA Psychiatry 2020; 77:1072-1080. [PMID: 32492095 PMCID: PMC7270886 DOI: 10.1001/jamapsychiatry.2020.1206] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE With the current opioid crisis, it is important to improve understanding of the biological mechanisms of opioid use disorder (OUD). OBJECTIVES To detect genetic risk variants for OUD and determine genetic correlations and causal association with OUD and other traits. DESIGN, SETTING, AND PARTICIPANTS A genome-wide association study of electronic health record-defined OUD in the Million Veteran Program sample was conducted, comprising 8529 affected European American individuals and 71 200 opioid-exposed European American controls (defined by electronic health record trajectory analysis) and 4032 affected African American individuals and 26 029 opioid-exposed African American controls. Participants were enrolled from January 10, 2011, to May 21, 2018, with electronic health record data for OUD diagnosis from October 1, 1999, to February 7, 2018. Million Veteran Program results and additional OUD case-control genome-wide association study results from the Yale-Penn and Study of Addiction: Genetics and Environment samples were meta-analyzed (total numbers: European American individuals, 10 544 OUD cases and 72 163 opioid-exposed controls; African American individuals, 5212 cases and 26 876 controls). Data on Yale-Penn participants were collected from February 14, 1999, to April 1, 2017, and data on Study of Addiction: Genetics and Environment participants were collected from 1990 to 2007. The key result was replicated in 2 independent cohorts: proxy-phenotype buprenorphine treatment in the UK Biobank and newly genotyped Yale-Penn participants. Genetic correlations between OUD and other traits were tested, and mendelian randomization analysis was conducted to identify potential causal associations. MAIN OUTCOMES AND MEASURES Main outcomes were International Classification of Diseases, Ninth Revision-diagnosed OUD or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision-diagnosed OUD (Million Veteran Program), and DSM-IV-defined opioid dependence (Yale-Penn and Study of Addiction: Genetics and Environment). RESULTS A total of 114 759 individuals (101 016 men [88%]; mean [SD] age, 60.1 [12.8] years) were included. In 82 707 European American individuals, a functional coding variant (rs1799971, encoding Asn40Asp) in OPRM1 (μ-opioid receptor gene, the main biological target for opioid drugs; OMIM 600018) reached genome-wide significance (G allele: β = -0.066 [SE = 0.012]; P = 1.51 × 10-8). The finding was replicated in 2 independent samples. Single-nucleotide polymorphism-based heritability of OUD was 11.3% (SE = 1.8%). Opioid use disorder was genetically correlated with 83 traits, including multiple substance use traits, psychiatric illnesses, cognitive performance, and others. Mendelian randomization analysis revealed the following associations with OUD: risk of tobacco smoking, depression, neuroticism, worry neuroticism subcluster, and cognitive performance. No genome-wide significant association was detected for African American individuals or in transpopulation meta-analysis. CONCLUSIONS AND RELEVANCE This genome-wide meta-analysis identified a significant association of OUD with an OPRM1 variant, which was replicated in 2 independent samples. Post-genome-wide association study analysis revealed associated pleiotropic characteristics. Recruitment of additional individuals with OUD for future studies-especially those of non-European ancestry-is a crucial next step in identifying additional significant risk loci.
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Affiliation(s)
- Hang Zhou
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven
| | - Christopher T. Rentsch
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zhongshan Cheng
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven
| | - Rachel L. Kember
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia,Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Yaira Z. Nunez
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven
| | - Richard M. Sherva
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, Massachusetts
| | - Janet P. Tate
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Cecilia Dao
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ke Xu
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven
| | - Lindsay A. Farrer
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, Massachusetts,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts,Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
| | - Amy C. Justice
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Yale School of Public Health, New Haven, Connecticut
| | - Henry R. Kranzler
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven,Department of Genetics, Yale University School of Medicine, New Haven, Connecticut,Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut
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11
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Edelman EJ, Li Y, Barry D, Braden JB, Crystal S, Kerns RD, Gaither JR, Gordon KS, Manhapra A, Merlin JS, Moore BA, Oldfield BJ, Park LS, Rentsch CT, Skanderson M, Williams EC, Justice AC, Tate JP, Becker WC, Marshall BD. Trajectories of Self-Reported Opioid Use Among Patients With HIV Engaged in Care: Results From a National Cohort Study. J Acquir Immune Defic Syndr 2020; 84:26-36. [PMID: 32267658 PMCID: PMC7147724 DOI: 10.1097/qai.0000000000002310] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND No prior studies have characterized long-term patterns of opioid use regardless of source or reason for use among patients with HIV (PWH). We sought to identify trajectories of self-reported opioid use and their correlates among a national sample of PWH engaged in care. SETTING Veterans Aging Cohort Study, a prospective cohort including PWH receiving care at 8 US Veterans Health Administration (VA) sites. METHODS Between 2002 and 2018, we assessed past year opioid use frequency based on self-reported "prescription painkillers" and/or heroin use at baseline and follow-up. We used group-based trajectory models to identify opioid use trajectories and multinomial logistic regression to determine baseline factors independently associated with escalating opioid use compared to stable, infrequent use. RESULTS Among 3702 PWH, we identified 4 opioid use trajectories: (1) no lifetime use (25%); (2) stable, infrequent use (58%); (3) escalating use (7%); and (4) de-escalating use (11%). In bivariate analysis, anxiety; pain interference; prescribed opioids, benzodiazepines and gabapentinoids; and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use. In multivariable analysis, illness severity, pain interference, receipt of prescribed benzodiazepine medications, and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use. CONCLUSION Among PWH engaged in VA care, 1 in 15 reported escalating opioid use. Future research is needed to understand the impact of psychoactive medications and marijuana use on opioid use and whether enhanced uptake of evidence-based treatment of pain and psychiatric symptoms can prevent escalating use among PWH.
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Affiliation(s)
- E. Jennifer Edelman
- Yale School of Medicine, New Haven, CT
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - Yu Li
- Brown University School of Public Health, Providence, RI
| | | | - Jennifer Brennan Braden
- University of Washington School of Medicine, Seattle, WA
- Valley Medical Center Psychiatry and Counseling, Behavioral Health Integration Program
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, Rutgers, NJ
| | - Robert D. Kerns
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | | | - Kirsha S. Gordon
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - Ajay Manhapra
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | | | - Brent A. Moore
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | | | | | - Christopher T. Rentsch
- VA Connecticut Healthcare System, West Haven, CT
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Emily C. Williams
- VA Puget Sound Health Services Research and Development and Department of Health Services, University of Washington, Seattle, WA
| | - Amy C. Justice
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - Janet P. Tate
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - William C. Becker
- Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
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