Candidate Metrics for Evaluating the Impact of Prescriber Education on the Safe Use of Extended‐Release/Long‐Acting ( ER/LA ) Opioid Analgesics

Objective The objective of this study was to develop metrics to assess opioid prescribing behavior as part of the evaluation of the E xtended‐ R elease/ L ong‐ A cting ( ER / LA ) Opioid Analgesic R isk E valuation and M itigation S trategies ( REMS ). Design Candidate metrics were selected using published guidelines, examined using sensitivity analyses, and applied to cross‐sectional rolling cohorts of M edicare patients prescribed with extended‐release oxycodone ( ERO ) between J uly 2, 2006 and J uly 1, 2011. Potential metrics included prescribing opioid‐tolerant‐only ER/LA opioid analgesics to non‐opioid‐tolerant patients, prescribing early fills to patients, and ordering drug screens. Results Proposed definitions for opioid tolerance were seven continuous days of opioid usage of at least 30 mg oxycodone equivalents, within the 7 days (primary) or 30 days (secondary) prior to first opioid‐tolerant‐only ERO prescription. Forty‐four percent of opioid‐tolerant‐only ERO episodes met the primary opioid tolerance definition; 56% met the secondary definition. Fills were deemed “early” if a prescription was filled before 70% (primary) or 50% (secondary) of the prior prescription's days' supply was to be consumed. Five percent (primary) and 2% (secondary) of episodes had more than or equal to two early fills during treatment. At least one drug screen was billed in 14% of episodes. Stratified analyses indicated that older patients were less likely to be opioid tolerant at the time of the first opioid‐tolerant‐only ERO prescription. Conclusions Investigators propose three metrics to monitor changes in prescribing behaviors for opioid analgesics that might be used to evaluate the ER / LA Opioid Analgesics REMS . Low frequencies of patients, particularly those >85 years, were likely to be opioid tolerant prior to receiving prescriptions for opioid‐tolerant‐only ERO .