title: National cohort study of opioid analgesic dose and risk of future hospitalization.
abstract: BACKGROUND
  High daily and total doses of opioid analgesics (OAs) increase the risk for drug overdose and may be risks for all-cause hospitalization.
  
  
  OBJECTIVE
  To examine the association of OA dose measures with future all-cause hospitalization.
  
  
  METHODS
  Cohort study of 87,688 national health maintenance organization enrollees aged 45 to 64 years with noncancer pain who filled ≥2 OA prescriptions from January 2009 to July 2012.
  
  
  METHODS
  Outcomes were all-cause hospitalization and hospital days in 6-month intervals after the first OA was filled. In generalized linear mixed models, we examined interactions of 5 daily OA dose categories and 5 total dose categories in each 6-month interval adjusted for demographics, clinical conditions, psychotropic drugs, and current hospitalization. For high total OA doses, percentage of days covered by OA prescriptions in 6 months was examined.
  
  
  RESULTS
  Over 3 years, an average of 12% of subjects were hospitalized yearly for a mean 6.5 (standard deviation = 8.5) days. Compared with no OAs, adjusted odds of future hospitalization for high total opioid dose (>1830 mg) were 35% to 44% greater depending on daily dose category (all P < 0.05), but total OA dose ≤1830 mg had weak or no association with future hospitalization regardless of daily OA dose. For high total OA doses, odds of hospitalization were 41% to 51% greater for categories of percentage of time on OAs above >50% (>3 months) versus no OAs (all P < 0.05). Similar effects were observed for hospital days.
  
  
  CONCLUSIONS
  Higher total OA doses for >3 months within a 6-month period significantly increased the risk for all-cause hospitalization and longer inpatient stays in the next 6 months.
authors.affiliation: Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.|Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas.|School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Liang
authors.affiliation: Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas.|School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas.|Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid