OBJECTIVES : Prevention and access to treatment for opioid addiction and overdose reversal drugs are critical to fighting this epidemic. Primary care settings have increasingly become a gateway to better care for individuals with both behavioral health (including substance use) and primary care needs. This research aims to identify opportunities to prevent new opioid use disorder cases.

METHODS : Over 100,000 deidentified, state-level patient claims records were analyzed to assess the likelihood of an opioid complication after receiving a prescription for opioids. Patient cohorts were defined as any patient who received at least one opioid as defined by the NDC database (n=9,088). The outcome variable was opioid complications defined as ICD-10 diagnosis categories of opioid poisoning or opioid abuse or opioid dependence. Logistic regression and decision tree analysis were run and compared included previous diagnosis of behavioral health issues, whether a patient was an adolescent between the ages of 12-17, gender, and race. Cohort creation and analyses were done using SAS for RWE and visualized with SAS Visual Statistics on Viya.

RESULTS : Our study showed that patients who have a behavioral health diagnosis are almost 55 times more likely to have an opioid complication if prescribed opioids than patients without such a diagnosis. (OR=54.79 CI:[16.50,339.14]) The decision tree also showed similar results, though it was a better model than the logistic regression. (KS Youden 0.70 vs. 0.69)

CONCLUSIONS : Electronic medical records should identify patients who had a previous behavioral health diagnosis to receive alternative therapies to opioids for pain management. Intervention at this patient level is crucial to stemming the opioid crisis in potentially vulnerable patient cohorts.