(C-088) Patterns of Opioid Reinitiation: Insights from US National Data (2018-2022)

Background: Opioids are a leading cause of prescription overdose and death in the US. Upon review of national opioid drug utilization data, twenty percent of incident patients reinitiate opioid treatment over a span of 5 years. Understanding the patterns of reinitiation can provide insight into early detection of opioid use disorder (OUD) and prediction of OUD triggered by provider re-prescribing.

Objectives: Evaluate patterns of FDA Risk Evaluation and Mitigation Strategy (REMS) opioid reinitiation after initial index in the USA; describe demographic, prescriber, and prescription characteristics among reinitiating patients between 2018 to 2022 (hereafter termed study assessment period); discuss study-design considerations of reinitiators.

Methods: This retrospective cohort study used IQVIA’s Longitudinal Prescription (LRx) retail database which captures 92% of retail pharmacy prescriptions in the USA. Patients were included if they had: ≥1 prescription REMS opioid claims during the study assessment period for an opioid during each calendar year, continuous eligibility in the LRx database during the year analyzed, and no opioid claims 12-months prior to index. Study outcomes were total annual number of patients who re-index, stratified by extended release/long acting (ER/LA) and immediate release (IR) opioids. Age, sex, and prescriber specialty descriptive analyses were also performed.

Results: Among 104,262,252 incident patients, 20,842,893 reinitiated at least one time during the study period. Majority of reinitiators were female (n=12,422,524 59.6%); mean [SD] age was 52.74 [18.26] years. Of patients who reinitiated opioids, 18,439,860 (88.47%) reindexed once, 2,311,261 (11.09%) two times, 90,901 (0.43%) three times, and 871 (0.004%) four times. The total number of patients, irrespective of reinitiation, decreased by 12.63% over the study period. Between 2019 to 2022, we observed a 78.32% increase in reinitiators, majority (>99.5%) of reinitiators were prescribed IR products. We also observed a modest increase (74.99%) in ER/LA reinitators between 2019 to 2022, and an 73.06% increase in reinitiators prescribed IR and ER/LA at index. Most reinitiators received opioids from Dentists, Physician Assistants, Emergency Physicians, Family Medicine Physicians, and Nurse Practitioners.

Conclusions: Although the overall number of incident opioid patients decreased between 2018 and 2022, we observed an increase in opioid reinitiators. Potential patient reinitiation must be evaluated in longitudinal and descriptive studies of incident patients to inform washout periods, minimize threats to bias, and identify early signs of prescription-use disorders.