Dose Escalation During the First Year of Long-Term Opioid Therapy for XXXX .

@entity1 @entity4512 @entity1118
OBJECTIVE: To identify @entity1 factors and health care utilization patterns associated with dose escalation during the first year of long-term opioid therapy for @entity1118 . DESIGN: Retrospective cohort study using electronic health record data. SETTING: University health system. SUBJECTS: Opioid na  ve adults with @entity4512 who received a new outpatient opioid prescription between July 1, 2011 and June 30, 2012 and stayed on opioids for 1 year. METHODS: Mixed-effects regression was used to estimate @entity1 ' rate of opioid dose escalation. Demographics, clinical characteristics, and health care utilization for @entity1 with and without dose escalation were compared. RESULTS: Twenty-three (9%) of 246 @entity1 in the final cohort experienced dose escalation (defined as an increase in mean daily opioid dose of >= 30-mg morphine equivalents over 1 year). Compared with @entity1 without dose escalation, @entity1 with escalation had higher rates of substance use diagnoses (17% vs 1%, P   =   0.01) and more total outpatient encounters (51 vs 35, P   =   0.002) over 1 year. Differences in outpatient encounters were largely due to more non face-to-face encounters (e.g., telephone calls, emails) among @entity1 with dose escalation. Differences in age, race, concurrent benzodiazepine use, and mental health diagnoses between @entity1 with and without dose escalation were not statistically significant. Primary care clinicians prescribed 89% of opioid prescriptions. CONCLUSIONS: Dose escalation during the first year of long-term opioid therapy is associated with higher rates of substance use disorders and more frequent outpatient encounters, especially non face-to-face encounters.
