title: Opioid Treatment Patterns Following Prescription of Immediate-Release Hydrocodone.
abstract: BACKGROUND
  Immediate-release (IR) hydrocodone is the most widely prescribed opioid in the United States; however, little is known about the utilization patterns and duration of opioid use among patients prescribed IR hydrocodone. A better understanding of the use of IR hydrocodone would result in more appropriate prescribing patterns of extended-release opioids.
  
  
  OBJECTIVE
  To assess downstream length of opioid therapy and utilization patterns of extended-release/long-acting (ER/LA) opioids among patients on IR hydrocodone to provide a better understanding of how IR and ER/LA opioids are used to manage pain.
  
  
  METHODS
  Retrospective analysis using health care claims from the Truven MarketScan Commercial, Medicare Supplemental, and Medicaid databases was performed. Patients prescribed IR hydrocodone during the 6-month baseline period (July 2011-December 2011) and with continuous enrollment for a 12-month follow-up period (2012) post-index date (January 1, 2012) were selected. Downstream length of therapy, defined as number of days supplied with opioids, and downstream use of ER/LA opioids during follow-up were examined by average pills per month (≤ 60 vs. > 60 pills per month) and days supply (< 60 vs. ≥ 60 days supply) of IR hydrocodone during baseline to mimic intermittent and consistent IR users.
  
  
  RESULTS
  At baseline, 1,743,933 commercial, 277,096 Medicare, and 157,922 Medicaid IR hydrocodone patients were identified. During follow-up, 1.7%, 2.9%, and 2.8% of patients initiated (i.e., converted to or newly started) ER/LA opioids for commercial, Medicare, and Medicaid groups, respectively. Approximately 90% of patients were prescribed IR hydrocodone for less than 2 months in the following year, while 10% were high utilizers, averaging nearly 8 months of prescribed opioid use during follow-up. Downstream initiation of ER/LA opioids was significantly higher among commercial patients prescribed IR hydrocodone for > 60 pills per month than with ≤ 60 pills per month (7.8% vs. 1.2%, respectively, P < 0.05) at baseline. For commercial patients initiating ER/LA opioids, length of ER/LA therapy during follow-up was significantly longer among patients with baseline IR hydrocodone > 60 pills per month than with ≤ 60 pills per month. All results were consistent when examined by levels of days supply.
  
  
  CONCLUSIONS
  A majority of the population prescribed IR hydrocodone was not prescribed opioid therapy beyond 2 months on average in the 1-year follow-up period. Only a small subset of patients with increased pills per month or days supply of IR hydrocodone in the baseline period continued to be high utilizers in the following year, averaging nearly 8 months of prescribed opioid use. A limited proportion of patients prescribed IR hydrocodone converted to ER/LA opioids. This knowledge can assist policymakers and physicians, providing an opportunity to identify small subsets of patients to improve ER/LA opioid prescribing.
  
  
  BACKGROUND
  Funding and support for this study was provided by Purdue Pharma L.P. Consulting fees were paid to Evidera by Purdue Pharma L.P. for this study. Kansal, Chitnis, and Paramore are employees of Evidera and were paid consultants to Purdue Pharma for this research. Holly is an employee for Purdue Pharma, and Bell and Ben-Joseph were full-time employees of Purdue Pharma during the design, planning, and execution of the studies and during the preparation of this manuscript. Burgoyne and Brixner were consultants on this project. Study design was created by Ben-Joseph, Brixner, Paramore, and Burgoyne. Data were collected by Kansal, Chitnis, Bell, Ben-Joseph, and Holly and interpreted by Ben-Joseph, Bell, Kansal, and Holly, with assistance from Brixner, Paramore, Burgoyne, and Chitnis. The manuscript was written by Ben-Joseph, Bell, Paramore, Chitnis, and Holly, with assistance from Kansal, and revised by Bell and Holly, along with Ben-Joseph, Brixner, Kansal, Paramore, Burgoyne, and Chitnis.
authors.affiliation: 1 Purdue Pharma L.P., Stamford, Connecticut.
authors.forename: Rami
authors.initials: R
authors.lastname: Ben-Joseph
authors.affiliation: 1 Purdue Pharma L.P., Stamford, Connecticut.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Bell
authors.affiliation: 2 Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City.
authors.forename: Diana
authors.initials: D
authors.lastname: Brixner
authors.affiliation: 3 Evidera, Lexington, Massachusetts.
authors.forename: Anuraag
authors.initials: A
authors.lastname: Kansal
authors.affiliation: 3 Evidera, Lexington, Massachusetts.
authors.forename: Clark
authors.initials: C
authors.lastname: Paramore
authors.affiliation: 3 Evidera, Lexington, Massachusetts.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Chitnis
authors.affiliation: 4 Medical Affairs Strategic Research, Purdue Pharma L.P., Stamford, Connecticut.
authors.forename: Pamela
authors.initials: P
authors.lastname: Holly
authors.affiliation: 5 Veridicus Health, Salt Lake City, Utah.
authors.forename: Douglas
authors.initials: D
authors.lastname: S Burgoyne
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003692:Delayed-Action Preparations; D065546:Drug Liberation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006853:Hydrocodone / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D006853:Hydrocodone