Table 3.
Operationalization of NMPO | |||||||
---|---|---|---|---|---|---|---|
First author/ year | Stated NMPOa concept | Diagnosis-based measure | Number of providers and pharmacies | Prescription-fill based measure | Urine toxicology | Exclusions | Data source(s) |
Braker 200927 | Potential Rxb opioid misuse | – | Received ≥3 opioid Rxs from ≥2 providers; ≥6 opioid Rxs within 6-monthsc | Yes/no record of opioid Rx | – | Pts d receiving short terms pharmacotherapy and those with cancer diagnosis | Publicly funded insurance: Upper Peninsula Health Plan (Medicaid MCO e) patients from a single family medicine practice |
Leider 201128 | Non-adherence among chronic opioid users | – | – | 120 days of a qualifying opioid within 6-months | Medication match and levels within expected ranges | Pts not matched to controls were excluded | Publicly funded insurance: Medicare advantage, and Medicaid plans; independent database of urine drug testing results |
Logan 201329 | Potential opioid misuse/ inappropriate Rx practices | – | – | Opioid Rxs overlapping ≥1 week; overlapping opioid and benzodiazepine Rxs; long-acting/ extended- release opioids for acute pain f; or ≥100 morphine milligram equivalent/ day | – | Pts not continuously enrolled in their plans for 1 year and those receiving opioid Rx for cancer pain | Commercial insurance: MarketScan® Commercial Claims and Encounter Database prepared by Truven Health |
Rice 201213 | Rx opioid abuse | 304.0X (opioid-type dependence), 304.7X (combinations of opioid-type dependence with any other drug dependence), 305.5X (nondependent opioid abuse), and 965.0 (poisoning by opiates/related narcotics) | – | Yes/no record of opioid Rx | – | Pts with heroin poisoning | Commercial insurance: Administrative claims data from a privately insured population (Ingenix Employer Solutoins, Eden Prarie, MN, USA) |
Roland 201330 | Diagnosed Rx opioid abuse | 304.0X, 304.7X, 305.5X, 965.00, 965.02 (methadone poisoning), and 965.09 (opiates poisoning not elsewhere classified) | – | – | – | No exclusions | Publicly funded and commercial insurance: MarketScan Commercial Claims and Encounters and Medicare Supplemental databases (Thomson Reuters®) |
Sullivan 2010 31 | Probable opioid misuse among chronic opioid users g | – | Number of prescribers (≤2, 3–4, ≥5); number of pharmacies (≤ 2, 3–4, ≥5) | Days of short acting opioids (91–185, 186–240, >240) and days of long acting opioids (91–185, 186–240, >240) within 6-months | – | Pts with cancer diagnosis (other than non-melanoma skin cancer), living in nursing homes, receiving hospice treatment, | Publicly funded and commercial insurance: HealthCore and Arkansas Medicaid |
White 200910 | Rx opioid abuse | 304.0, 304.7, 305.5, or 965.0 | – | Yes/no record of opioid Rx | – | Pts with heroin poisoning | Commercial insurance: Maine Health Data Organization |
NMPO=Non-medical use of prescription opioids.
Rx=Prescription.
A misuse score was generated based on individual variables predicting ≥6 opioid Rx within a 6 month period among those who had received ≥3 Rxs from ≥2 providers.
Pt=Patient.
MCO=Managed Care Organization.
See Leider et al. Table 2 footnote for definition and list of ICD-9 codes for conditions included as acute pain.
Composite misuse scores were generated and categorized: no misuse (≤ 1), possible misuse (2–4), and probable misuse (≥5).