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Matching Study Design to Prescribing Intention: The Prevalent New-User Design for Studying Abuse-Deterrent Formulations of Opioids
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  • Bethany L. DiPrete,
  • GYeon Oh,
  • Daniela Moga,
  • Nabarun Dasgupta,
  • Svetla Slavova,
  • Emily Slade,
  • Chris Delcher,
  • Brian W. Pence,
  • Shabbar Ranapurwala
Bethany L. DiPrete
The University of North Carolina at Chapel Hill Gillings School of Global Public Health

Corresponding Author:[email protected]

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GYeon Oh
University of Kentucky College of Pharmacy
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Daniela Moga
University of Kentucky College of Pharmacy
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Nabarun Dasgupta
The University of North Carolina at Chapel Hill Injury Prevention Research Center
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Svetla Slavova
University of Kentucky College of Public Health
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Emily Slade
University of Kentucky College of Public Health
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Chris Delcher
University of Kentucky College of Pharmacy
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Brian W. Pence
The University of North Carolina at Chapel Hill Gillings School of Global Public Health
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Shabbar Ranapurwala
The University of North Carolina at Chapel Hill Gillings School of Global Public Health
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Abstract

Purpose: In drug studies, research designs requiring no prior exposure to certain drug classes may restrict important populations. Since abuse-deterrent formulations (ADF) of opioids are routinely prescribed after other opioids, choice of study design, identification of appropriate comparators, and addressing confounding by “indication” are important considerations in ADF post-marketing studies. Methods: In a retrospective cohort study using claims data (2006-2018) from a North Carolina private insurer [NC claims] and Merative MarketScan [MarketScan], we identified patients (18-64 years old) initiating ADF or non-ADF extended-release/long-acting (ER/LA) opioids. We compared patient characteristics and described opioid treatment history between treatment groups, classifying patients as traditional (no opioid claims during prior six-month washout period) or prevalent new users. Results: We identified 8,415 (NC claims) and 147,978 (MarketScan) ADF, and 10,114 (NC claims) and 232,028 (MarketScan) non-ADF ER/LA opioid initiators. Most had prior opioid exposure (ranging 64-74%), and key clinical differences included higher prevalence of recent acute or chronic pain and surgery among patients initiating ADFs compared to non-ADF ER/LA initiators. Concurrent immediate-release opioid prescriptions at initiation were more common in prevalent new users than traditional new users. Conclusions: Careful consideration of the study design, comparator choice, and confounding by “indication” is crucial when examining ADF opioid use-related outcomes.
17 Jul 2023Submitted to Pharmacoepidemiology and Drug Safety
17 Jul 2023Submission Checks Completed
17 Jul 2023Assigned to Editor
17 Jul 2023Review(s) Completed, Editorial Evaluation Pending
26 Jul 2023Reviewer(s) Assigned
14 Mar 2024Assigned to Editor
14 Mar 2024Submission Checks Completed
14 Mar 2024Review(s) Completed, Editorial Evaluation Pending
17 Mar 2024Reviewer(s) Assigned
17 Apr 2024Editorial Decision: Accept