A retrospective cohort study of long-term immediate-release hydrocodone/acetaminophen use and acetaminophen dosing above the food and drug administration recommended maximum daily limit among commercially insured individuals in the United States (2008-2013)

Angela Deveaugh-Geiss, Aditi Kadakia, Howard Chilcoat, Louis Alexander, Paul Coplan

Research output: Contribution to journalArticle

Abstract

Immediate-release (IR) hydrocodone/acetaminophen is the most prescribed opioid in the United States; however, patterns of use, including long-term treatment and dose, are not well described. Duration of use, including the percentage of patients on long-term treatment (>90 days of continuous use), was assessed for patients newly prescribed IR hydrocodone/acetaminophen compared to other opioid analgesics in a national commercial insurance database (January 2008-September 2013). Though only a small percentage of IR hydrocodone/acetaminophen patients continued treatment long-term (1.7%), the number was large (104,839) and was nearly 5 times the number receiving extended-release (ER) morphine (n = 22,338) and nearly 4 times the number receiving ER oxycodone (n = 26,946) long-term. Using a less conservative allowable gap in treatment increased the number of patients meeting the criteria for long-term use (approximately 160,000 for IR hydrocodone/acetaminophen vs 20 and ≤60 mg/d (n = 56,220, 53.6%) in month 4; 5.5% (n = 5,743) received doses >60 mg/d. Moreover, approximately 15% of IR hydrocodone/acetaminophen patients (n > 900,000) were prescribed total daily acetaminophen doses exceeding 4 g (the limit recommended by the U.S. Food and Drug Administration) at their initial IR hydrocodone/acetaminophen prescription or any time during therapy. Perspective Although most patients were prescribed IR hydrocodone/acetaminophen for acute pain, the number of patients prescribed long-term therapy exceeds the number of patients prescribed ER opioids. It is important to consider the benefits and risks inherent with long-term opioid therapy, whether with IR or ER opioids, to ensure safe use of these products.

Original languageEnglish (US)
Pages (from-to)569-579.e1
JournalJournal of Pain
Volume16
Issue number6
DOIs
StatePublished - Jun 1 2015
Externally publishedYes

Fingerprint

United States Food and Drug Administration
Acetaminophen
Cohort Studies
Retrospective Studies
Opioid Analgesics
Therapeutics
Oxycodone
hydrocodone drug combination acetaminophen
Acute Pain
Insurance
Morphine
Prescriptions
Databases

Keywords

  • acetaminophen
  • Hydrocodone
  • immediate-release opioids
  • long-term opioid therapy
  • utilization

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Neurology
  • Clinical Neurology

Cite this

A retrospective cohort study of long-term immediate-release hydrocodone/acetaminophen use and acetaminophen dosing above the food and drug administration recommended maximum daily limit among commercially insured individuals in the United States (2008-2013). / Deveaugh-Geiss, Angela; Kadakia, Aditi; Chilcoat, Howard; Alexander, Louis; Coplan, Paul.

In: Journal of Pain, Vol. 16, No. 6, 01.06.2015, p. 569-579.e1.

Research output: Contribution to journalArticle

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abstract = "Immediate-release (IR) hydrocodone/acetaminophen is the most prescribed opioid in the United States; however, patterns of use, including long-term treatment and dose, are not well described. Duration of use, including the percentage of patients on long-term treatment (>90 days of continuous use), was assessed for patients newly prescribed IR hydrocodone/acetaminophen compared to other opioid analgesics in a national commercial insurance database (January 2008-September 2013). Though only a small percentage of IR hydrocodone/acetaminophen patients continued treatment long-term (1.7{\%}), the number was large (104,839) and was nearly 5 times the number receiving extended-release (ER) morphine (n = 22,338) and nearly 4 times the number receiving ER oxycodone (n = 26,946) long-term. Using a less conservative allowable gap in treatment increased the number of patients meeting the criteria for long-term use (approximately 160,000 for IR hydrocodone/acetaminophen vs 20 and ≤60 mg/d (n = 56,220, 53.6{\%}) in month 4; 5.5{\%} (n = 5,743) received doses >60 mg/d. Moreover, approximately 15{\%} of IR hydrocodone/acetaminophen patients (n > 900,000) were prescribed total daily acetaminophen doses exceeding 4 g (the limit recommended by the U.S. Food and Drug Administration) at their initial IR hydrocodone/acetaminophen prescription or any time during therapy. Perspective Although most patients were prescribed IR hydrocodone/acetaminophen for acute pain, the number of patients prescribed long-term therapy exceeds the number of patients prescribed ER opioids. It is important to consider the benefits and risks inherent with long-term opioid therapy, whether with IR or ER opioids, to ensure safe use of these products.",
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