Opioid Prescription Patterns for Adults With Longstanding Disability and Inflammatory Conditions Compared to Other Users, Using a Nationally Representative Sample

Independent and joint contributions of physical disability and chronic pain to incident opioid use disorder and opioid overdose among Medicaid patients

BACKGROUND

Chronic pain has been extensively explored as a risk factor for opioid misuse, resulting in increased focus on opioid prescribing practices for individuals with such conditions. Physical disability sometimes co-occurs with chronic pain but may also represent an independent risk factor for opioid misuse. However, previous research has not disentangled whether disability contributes to risk independent of chronic pain.

METHODS

Here, we estimate the independent and joint adjusted associations between having a physical disability and co-occurring chronic pain condition at time of Medicaid enrollment on subsequent 18-month risk of incident opioid use disorder (OUD) and non-fatal, unintentional opioid overdose among non-elderly, adult Medicaid beneficiaries (2016-2019).

RESULTS

We find robust evidence that having a physical disability approximately doubles the risk of incident OUD or opioid overdose, and physical disability co-occurring with chronic pain increases the risks approximately sixfold as compared to having neither chronic pain nor disability. In absolute numbers, those with neither a physical disability nor chronic pain condition have a 1.8% adjusted risk of incident OUD over 18 months of follow-up, those with physical disability alone have an 2.9% incident risk, those with chronic pain alone have a 3.6% incident risk, and those with co-occurring physical disability and chronic pain have a 11.1% incident risk.

CONCLUSIONS

These findings suggest that those with a physical disability should receive increased attention from the medical and healthcare communities to reduce their risk of opioid misuse and attendant negative outcomes.

Associations Between Opioid Prescriptions and Use of Hospital-Based Services Among US Adults with Longstanding Physical Disability or Inflammatory Conditions Compared to Other Adults in the Medical Expenditure Panel Survey, 2010-2015

Purpose

To investigate the association of filling opioid prescriptions with healthcare service utilization among a nationally representative sample of adults with disability.

Materials and Methods

The Medical Expenditure Panel Survey (MEPS) for 2010-2015, Panels 15-19, was used to identify adults who were prescribed opioids during each two-year period. We examined the data for associations between opioid prescription filling and the number of emergency department (ED) visits and hospitalizations. The participants were grouped as those with inflammatory conditions or with longstanding physical disability, and a comparison group of those without these conditions.

Results and conclusions

Opioid prescription filling differed among adults with inflammatory conditions and longstanding physical disability compared to the comparison group (44.93% and 40.70% vs 18.10%, respectively). For both groups of people with disability, the relative rates for an ED visit or hospitalization were significantly higher for those who filled an opioid prescription, compared to adults with the same conditions who did not fill an opioid prescription. People with a longstanding physical disability who filled an opioid prescription had the highest rate ratio of ED use and hospitalization. Results from this investigation demonstrate that opioid prescription filling among persons with inflammatory conditions and longstanding physical disabilities is associated with higher rates of ED visits and hospitalizations.

The Association of Opioid Misuse and Suicidality among People with Disabilities

Background/Purpose: Past research has linked non-medical prescription opioid use (NMPOU) with suicide, though less focus has been placed among people with disabilities impacted by the opioid epidemic. This study examined the relationship of NMPOU and suicidality among people with and without disabilities while controlling for sociodemographic and other variables. Method: Using the 2019 National Survey on Drug Use and Health, weighted logistic regression analyses were conducted on a cross-sectional sample of 38,088 respondents 18 and older to examine the effect of opioid misuse and disability on serious thoughts of suicide, having a suicide plan, and making a suicide attempt. Results: Findings indicated opioid misuse was associated with 37% higher odds for having a suicide plan in the past year (OR = 1.37, p < .05). The main results indicated the people with disabilities had 30% higher odds for having a suicide plan (OR = 1.30, p < .05) and 73% higher odds for a suicide attempt in the past year (OR = 1.73, p < .001). Interaction analysis found that opioid misuse was associated with higher odds for having a suicide plan (OR = 1.89, p < .01), and having a suicide attempt among those with disabilities (OR = 2.57, p < .01). Conclusion: Results indicated that opioid misuse is a risk factor for suicide, and people with disabilities were at greater risk. Health workers can serve as a nexus point in effectively engaging at-risk people with disabilities in substance use and mental health prevention and recovery services.

Neonatal Outcomes of Mothers With a Disability

OBJECTIVES

To assess the risk of neonatal complications among women with a disability.

METHODS

This population-based cohort study comprised all hospital singleton livebirths in Ontario, Canada from 2003 to 2018. Newborns of women with a physical (N = 144 187), sensory (N = 44 988), intellectual or developmental (N = 2207), or ≥2 disabilities (N = 8823) were each compared with 1 593 354 newborns of women without a disability. Outcomes were preterm birth <37 and <34 weeks, small for gestational age birth weight (SGA), large for gestational age birth weight, neonatal morbidity, and mortality, neonatal abstinence syndrome (NAS), and NICU admission. Relative risks were adjusted for social, health, and health care characteristics.

RESULTS

Risks for neonatal complications were elevated among newborns of women with disabilities compared with those without disabilities. Adjusted relative risks were especially high for newborns of women with an intellectual or developmental disability, including preterm birth <37 weeks (1.37, 95% confidence interval 1.19-1.58), SGA (1.37, 1.24-1.59), neonatal morbidity (1.42, 1.27-1.60), NAS (1.53, 1.12-2.08), and NICU admission (1.53, 1.40-1.67). The same was seen for newborns of women with ≥2 disabilities, including preterm birth <37 weeks (1.48, 1.39-1.59), SGA (1.13, 1.07-1.20), neonatal morbidity (1.28, 1.20-1.36), NAS (1.87, 1.57-2.23), and NICU admission (1.35, 1.29-1.42).

CONCLUSIONS

There is a mild to moderate elevated risk for complications among newborns of women with disabilities. These women may need adapted and enhanced preconception and prenatal care, and their newborns may require extra support after birth.

Mid-quantile regression for discrete responses

We develop quantile regression methods for discrete responses by extending Parzen’s definition of marginal mid-quantiles. As opposed to existing approaches, which are based on either jittering or latent constructs, we use interpolation and define the conditional mid-quantile function as the inverse of the conditional mid-distribution function. We propose a two-step estimator whereby, in the first step, conditional mid-probabilities are obtained nonparametrically and, in the second step, regression coefficients are estimated by solving an implicit equation. When constraining the quantile index to a data-driven admissible range, the second-step estimating equation has a least-squares type, closed-form solution. The proposed estimator is shown to be strongly consistent and asymptotically normal. A simulation study shows that our estimator performs satisfactorily and has an advantage over a competing alternative based on jittering. Our methods can be applied to a large variety of discrete responses, including binary, ordinal, and count variables. We show an application using data on prescription drugs in the United States and discuss two key findings. First, our analysis suggests a possible differential medical treatment that worsens the gender inequality among the most fragile segment of the population. Second, obesity is a strong driver of the number of prescription drugs and is stronger for more frequent medications users. The proposed methods are implemented in the R package Qtools. Supplemental materials for this article, including a brief R tutorial, are available as an online supplement.

Examining differences in prescription opioid use behaviors among U.S. adults with and without disabilities

We aimed to identify differences in prescription opioid-related behaviors between adults with and without disabilities in the U.S. We analyzed data from the 2015-2017 National Survey on Drug Use and Health (128,740 individuals; weighted N of 244,831,740) to examine disability-based differences in (1) reasons and sources of last prescription opioid misuse and, in multivariate models overall and stratified by disability, the likelihood of (2) prescription opioid use, and if used, (3) misuse and prescription opioid use disorder (OUD), overall and stratified by disability. Adults with disabilities were 11% more likely than adults without disabilities to report any past-year prescription opioid use, adjusted for sociodemographic, health, and behavioral health characteristics. However, among adults with any prescription opioid use, which is more common among people with disabilities, likelihood of prescription OUD did not vary by disability status. Pain relief as the reason for last misuse was associated with 18% increased likelihood of prescription OUD, if any use. To reduce risk of opioid misuse among people with disabilities, accessible and inclusive chronic pain management services are essential. Further, the substance use treatment field should provide accessible and inclusive services, and be aware of the need for pain management by many people with disabilities, which may include the use of prescription opioids. These findings highlight essential opportunities for public health and policies to improve access, accommodations, and quality of health and behavioral health care for people with disabilities, and to encourage a holistic perspective of people with disabilities and their needs.

Prescription Drug Monitoring Programs and Opioid Prescriptions for Disability Conditions

BACKGROUND

There are variants of prescription drug monitoring programs (PDMPs) and different groups of patients who are prescribed opioids. Patients with disabilities and those with chronic conditions might have different experiences in physician prescribing practices for opioids, when compared to a comparison group without these conditions.

OBJECTIVE

To determine differences in opioid prescriptions related to PDMPs for people without cancer-related pain and with disability conditions compared to other adult opioid users without cancer, using a national database.

METHOD

Opioid users were identified from the US Medical Expenditure Panel Survey. Disability groups were defined by diagnosis codes related to longstanding physical disability and inflammatory conditions. Our analyses used an event study framework and a difference-in-differences approach.

RESULTS

During a two-year panel period, PDMPs did not reduce opioid prescriptions for individuals with disabilities who use opioids. Our data show that individuals with disabilities who use opioids, on average, have a higher incidence of continuous opioid use and significantly greater amounts prescribed compared to other adults who have opioid prescriptions.

CONCLUSION

PDMPs do not appear to affect prescribers' initial or ongoing use of opioids for individuals with longstanding physical disabilities and those with inflammatory conditions. Thus, these adults have greater exposure to opioids, compared to other adults who were prescribed opioids.

A systematic scoping study exploring opioid use across a variety of disability conditions

BACKGROUND

Opioid use experiences among people with disability (PWD) as a group has not been clearly articulated in the current literature, despite links between pain and measures of disability.

OBJECTIVE

To conduct a systematic search and scoping study examining the characteristics of current literature focused on opioid use among PWD.

METHODS

Four databases were queried (i.e., Medline, PsycINFO, Embase, and CINAHL) for peer-reviewed, empirical, English-language, journal articles focused on long-term opioid use among PWD. Collected data points included: disability details (specific condition, onset of disability), opioid details (category of opioid use, and specified substance), study details, and design.

RESULTS

A total of 196 articles were included, with 83.7% published since 2000 largely from the US. The majority of articles (70.4%) focused on the use of opioids as medical treatment, with fewer articles focusing on recreational opioid use or substance use disorders. The majority of included sources (73%) focused on opioid use in acquired conditions; neuropathic pain (21.9%) and attention deficit hyperactivity disorder (20.4%) were the most commonly studied. Differences were observed in the distribution of disability conditions across category of opioid use and study design classification; 73.5% were considered observational in design.

CONCLUSIONS

The varied representation of disability conditions, and differences across opioid use category and study design classification point to a complicated relationship between opioid use and disability. The present research portfolio would benefit from research matching informational needs of a specific disability area or opioid use category to provide the evidence necessary to advance current knowledge and promote inclusion in national agendas.