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Long-term use of hydrocodone vs. oxycodone in primary care; Harris, et al

Long-term use of hydrocodone vs. oxycodone in primary care; Harris, et al

Nov 7, 2019

Long-term use of hydrocodone vs. oxycodone in primary care

Rebecca Arden Harris, Henry R.Kranzler, Kyong-Mi Chang, Chyke A.Doubenia, Robert Gross

Highlights

• Hydrocodone and oxycodone are the most prescribed Schedule II opioids.

• Equianalgesic opioids are widely assumed to induce similar rates of long-term use.

• Hydrocodone had a 9% greater risk of long-term use than oxycodone.

• The increased risk was 17% among patients who received more than one prescription.

 

Abstract

Background

Hydrocodone and oxycodone are the Schedule II opioids most often prescribed in primary care. Notwithstanding the dangers of prescription opioid use, the likelihood of long-term use with either drug is presently unknown.

Methods

Using a retrospective cohort design and data from a commerical healthcare claims repository, we compared the likelihood of long-term use of hydrocodone and oxycodone in primary care patients presenting with acute back pain. Treatment was categorized as long-term if the prescription dates spanned ≥90 days from initial prescription to the run-out date of the last prescription, and included ≥120 days’ supply or ≥10 fills. Instrumental variable methods and probit regression were used to model the effect of drug choice on long-term use, estimate the average treatment effect, and correct for confounding by indication.

Results

A total of 3,983 patients who were prescribed only hydrocodone or only oxycodone were followed for 270 days in 2016. Long-term opioid use was observed in 320 patients (8%). Controlling for potential confounders including morphine milligram equivalents and dosage, an estimated 12% (95 CI, 10%–14%) treated with hydrocodone transitioned to long-term use vs. 2% (95 CI, 1%–3%) on oxycodone. Among patients who received more than one prescription (n = 1,866), an estimated 23% (95 CI, 19%–26%) treated with hydrocodone transitioned to long-term use vs. 5% (95 CI, 3%–7%) on oxycodone. The difference between drugs was supported in sensitivity and subgroup analyses. Sample selection bias was not detected.

Conclusions

Long-term use was substantially greater for patients treated with hydrocodone than oxycodone, despite equianalgesia.

 

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About CPeRT

Center for Pharmacoepidemiology Research and Training (CPeRT) members are leaders in the development and use of large administrative and medical record databases for studying drug effects. CPeRT is one of the academic partners of the Food and Drug Administration (FDA)-funded Mini-Sentinel Initiative. CPeRT members also edit Pharmacoepidemiology, 5th edition and Textbook of Pharmacoepidemiology.

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