Study identifies populations at risk for high-dose opioid prescriptions

Researchers from the University of Missouri School of Medicine have shed light on what populations are more likely to be prescribed a high dose of opioid medication. This increases their risk of developing opioid use disorder.

Opioids like hydrocodone or oxycodone are typically prescribed to relieve intense pain. A prescription can become an addiction; side effects include building a tolerance to the medication – so the patient has to take a higher dose to feel relief – or becoming physically dependent on the drug. These effects can happen quickly, even when taking opioids as prescribed.

Many factors increase the risk of developing opioid use disorder. These include the severity of pain itself, how long opioids are used, their dosage and other medical conditions, such as neurologic or mental health disorders."

Mirna Becevic, study author 

To determine the populations most at-risk, Becevic and her team combed through over 3 million records of Medicaid claims in Missouri from 2017 to 2021. The study had a total of 306,432 observations, which was compared against 2018 USA census data and data from 2020 detailing the primary care shortage.

Becevic and her team found that male patients and people in the middle age range up to 60 years old were more likely to be prescribed a high dose of opioids. They observed a more conservative prescribing pattern for younger adults, which may be because of increased awareness about the opioid epidemic.

"Incidence of chronic pain increases with age, which may have affected the prescribing patterns we saw," Becevic said. "Interestingly, the risk of prescription past age 60 sharply declined, though this could be because of the increased risk of adverse effects and potential drug interactions."

Researchers also determined that areas with the largest risk of high-dose opioids correlated with areas that tended to be more urban and had higher percentages of veterans and primary care providers.

"These findings emphasize the need for public health strategies to address the opioid crisis," Becevic said. "Opportunities are available for clinicians interested in learning more about evidence-based treatment for pain and opioid use disorder, including our Show Me ECHO program."

While current clinical guidelines say high-dose opioids prescriptions should be avoided, it remains a common practice in certain areas. Since the study used only Missouri data, Becevic says the findings may not be relevant to other populations in the United States.

"Other states and regions have their own unique demographics, policies and health care access," Becevic said. "Further studies should investigate long-term trends and why doctors prescribe high-dose opioids. Our study's findings, however, help identify risk factors for all Missouri patients."

Mirna Becevic, PhD is an assistant professor of dermatology at the MU School of Medicine. Her research focuses on telemedicine and telehealth.

"Identifying high-dose opioid prescription risks using machine learning: A focus on sociodemographic characteristics" was recently published in the Journal of Opioid Management. In addition to Becevic, MU study authors include Olabode Ogundele, PhD, with the Institute for Data Science and Informatics and the Missouri Telehealth Network; Butros Dahu, PhD, with the Institute for Data Science and Informatics; Praveen Rao, PhD, associate professor of electrical engineering and computer science; Xing Song, PhD, assistant professor of Biomedical Informatics, Biostatistics and Medical Epidemiology; Timothy Haithcoat, PhD, assistant teaching professor of Data Science and Analytics; and Tracy Greever-Rice, PhD, Director of the MU Center for Health Policy. Other authors include Mutiyat Hameed, from SSM Health, and Douglas Burgess, MD, assistant professor of psychiatry at University of Missouri – Kansas City.