ehr characteristics in opioid use disorders wade
43
EHR Characteristics in Opioid Use Disorders Wade Berrettini, MD, PhD Karl E. Rickels Professor of Psychiatry Perelman School of Medicine University of Pennsylvania ([email protected]) Adjunct Professor, Geisinger Clinic Danville, PA Pain is a more terrible lord of mankind than even death itself. Albert Schweitzer, MD, 1931.
TRANSCRIPT
EHR Characteristics in Opioid Use Disorders
Wade Berrettini MD PhD Karl E Rickels Professor of PsychiatryPerelman School of MedicineUniversity of Pennsylvania(wadebpennmedicineupennedu)Adjunct Professor Geisinger ClinicDanville PA
Pain is a more terrible lord of mankind than even death itselfAlbert Schweitzer MD 1931
Topics to be Discussed
Risk for OUD among Geisinger patients with non-progressive musculo-skeletal pain who are prescribed opioids for months
Genetics of opioid dose at Geisinger
Neonatal opioid withdrawal syndrome at Geisinger
~40-50 years ago research (see for example Marks amp Sachar 1973) indicated that physicians were too restrictive in prescribing opioids for severe pain resulting in undue suffering
But beginning ~30 years ago a few pharmaceutical companies (Purdue) distributed widely to physicians poorly designed studies which seemed to indicate that risk for addiction was negligible if opioids were given for chronic non-progressive pain
The resulting increase in opioid prescriptions has led (predictably) to a large increase in opioid addiction
New England Journal of Medicine 302 123 1980
In the 1990s physicians began to prescribe opioids for non-progressive musculo-skeletal pain leading to increases in OUD
Opioids are very good for acute pain they should not be used forchronic pain due to side effects tolerance and risk for OUD
Presenter
Presentation Notes
This letter to the editor was widely distributed to physicians (by a few pharmaceutical companies) as strong evidence that opioids could be prescribed for chronic pain with little risk for addiction
JAMA 2018
OUD Epidemiology in 6 Healthcare Systems
Lapham G et alDrug Alc Dep 2020
OUD Patients Treated with Buprenorphine
Lapham G et al Drug Alc Dep 2020
Clinical Enterprise14 hospitals~70 community practices 2 million patientsEPIC EHR since 1996Standardized diagnostics DNA amp biofluids bank (MyCode)Accredited medical schoolPatient PopulationStable NE PA population97 European ancestryEngaged patientsWhole exome sequencing amp array genotyping of patient population in progress 145Ksamples completed
Geisinger An Integrated Health Care Delivery System
Patient consent occurs during an outpatient visitConsent creates order for a research blood tube to be drawn at next clinically-indicated phlebotomyRe-contact allowed for return of medically-actionable results from DNA sequencing amp for research purposesgt300000 patient participants
Geisinger Biobank (MyCode) Participants 5000+1-5000
PatientsConsented
500-999100-499
50-99 25-491-24
Phila
Scranton
Danville
Opioid Overdose Deaths by PA County in 2016 per 100000 Persons
0
5
10
15
20
25
30
35
40
Lackawanna Schuylkill Columbia Montour Lycoming Luzerne
3950 opioid deaths in PA in 2016 or 31100000 representing a 37 increase over 2015
52 of PA opioid deaths involved fentanyl45 of PA opioid deaths involved heroin
42249 US opioid overdose deaths in 2016
Presenter
Presentation Notes
The recently released 2017 data show a ~20 increase in opioid deaths in PA
Geisinger requires opioid-treated chronic non-progressive pain patients to follow guidelines for opioid use through a Prescription Drug Medication Program (PDMP) including a Medication Use Agreement (MUA take only opioid provided by designated Geisinger MD random UDSs lsquolostrsquo medications will not be replaced minimum twice monthly clinic visits etc)
An MUA (site-specific ICD code) is often instituted by the primary care physician if opioid misuse is suspected The MUA is either maintained (PDMP-M) or it is violated and terminated (PDMP-V)
We hypothesized that PDMP-M and PDMP-V groups would have electronic health record (EHR) evidence of OUD We reviewed 100 PDMP-M 100 PDMP-V and 200 control EHRs from patients treated at least 90 days with opioids (typically for chronic musculo-skeletal non-progressive pain) Patients were matched on age duration of opioid use gender ethnicity (gt95 European ancestry) Patients with metastatic cancer or other types of progressive pain were excluded 11
12
Geisinger Patients Treated with Opioids for gt60 Days for Non-Progressive Musculo-skeletal Pain
MUA TMUA CONTROL
matched fordemographics
Demographics for Chart Review Sampleof PDMP and Control Patients
PDMP Control p-value
Sample DemographicsN 200 200
Male 84 79Female 116 121
Age 4806 (1046) 482 (1073) 895E-01BMI 3087 (802) 3131 (824) 591E-01
Health Record DataMean EHR length in days 407666 (190227) 382926 (184380) 312E-01Mean number of ER visits 1264 (3298) 449 (615) 675E-03
Mean daily MME 5173 (3522) 3577 (1901) 995E-02
612E-01
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
ICD-10 EHR Diagnoses for Chart Review Sample of PDMP and Control Patients
p-value
Description Distinct patient of pts Distinct patient of ptsTotal 200 200Depression 82 41 33 17 114E-07Anxiety disorder 92 46 39 20 302E-08Depression amp Anxiety disorder 52 26 15 8 143E-06Total 200 200Alcohol 7 4 3 2 337E-01Nicotine 85 43 53 27 111E-03Opioid 6 3 0 0 397E-02Other Substance Abuse 9 5 1 1 250E-02
PDMP Control
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
ICD10 Opioid Use Disorder bull Tolerance (not counted if medication is prescribed by MD)bull Withdrawal (ditto)bull More use of opioids than intendedbull Craving for opioidsbull Unsuccessful efforts to cut downbull Spends excessive time in acquisitionbull Activities given up because of usebull Uses despite negative effectsbull Failure to fulfill major role obligationsbull Recurrent use in hazardous situations (eg while driving)bull Continued use despite social or interpersonal problems
Severity judged by numbers of symptoms 2-3 mild 4-6 moderate 7-11 severe
Presenter
Presentation Notes
When the patient is taking opioids chronically for persistent non-progressive musculo-skeletal pain it may be difficult to determine (for example) whether activities are avoided due to opioid use or due to pain Similarly it may be difficult to distinguish between opioid craving for euphoria versus desire for drug due to re-emergence of pain
16
1 2 3 4 5 6 7 8 9 Vocational Interference Due to Drug Use or Pain X X X
Disabled X X X
Was Weaning Described as Unsuccessful or Difficult X
Positive Tox Screen for Opioids other than Prescribed X X X X X
Lost Pills X X
Multiple Opioid Prescribers X X
Multiple Pharmacies X X
Early Prescription Refills X X
Opioid Overdose X X
Substance Abuse X X
Hazardous Situation as Result of Opioid X
Interpersonal or Legal Issues as Result of Opioid X X X
Medical Issues as Result of Opioid X X
Craving X X
Provider Mentioned Drug-seeking behavior X X X X X
DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems
EHR Search Category DSM-5 Criteria for OUD
EHR Search Methodology for DSM-V OUD Symptoms
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
Demographics amp OUD Symptoms in 200 Patients Treated Chronically with Opioids for Non-progressive Pain
(morphine mg equiv)
18
Rates of DSM-VOUD Dx by chart review in the control (n=200) PDMP (n=200)patients
Rates of DSM-VOUD Dx by chart review in the PDMP-M (n=100) and PDMP-V (n=100) patients
13 of control patients have moderate or severe OUD
PDMP Control p-value
Sample Demographics
N 16253 16253
Male 6944 6949 928E-01Female 9309 9304
Age 5188 (137) 50 (1465) 624E-33
BMI 3169 (84) 3145 (837) 963E-03
Health Record Data
Mean EHR length in days 4211 (207376) 2650 (23522) ltE-200
Mean number of ER visits 8552 (1599) 357 (514) 358E-184
Mean daily MME 5174 (782) 4432 (718) 532E-20
Demographics for Entire Sampleof PDMP and Control Patients
EHR Diagnoses for Entire Sampleof PDMP and Control Patients
Alcohol 489 301 137 083 149E-45Nicotine 4760 2929 1523 926 000E+00Opioid 291 179 48 029 741E-40Other Substance Abuse 570 351 106 064 210E-72
Description Distinct patient of pts Distinct patient of pts p-valueTotal 16253 16253Depression 5446 3351 1473 906 000E+00Anxiety disorder 6552 4031 1605 988 000E+00
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
Methods
Genotypes---GWAS array genotypes for common alleles bull Whole exome sequencing (WES) Imputed (1000 Genomes) bull Phenotypes bull Opioid prescription dosage from EHR medication records years 2012-17
gt 90 days of opioid prescribed 90 days max gap among prescriptions (90-90 Rule) Final regular dose Morphine milligram equivalents (MME) Excluded patients with ICD codes for metastatic cancer and hospice Vast majority of patients had non-progressive musculo-skeletal pain 97 of patients had European-American ancestry by DNA analysis
bull Any opioid (oxycodone tramadol hydrocodone most common)Covariates bull Sex Age Age2 Principle Components 1-4 from population substructure analysis
Association Tests bull Mixed Linear Model Association analysis by GCTA + FASTBAT
Discovery set First 90000 Geisinger patients with WESReplication Next 60000 Geisinger patients Million Veteran Program
21
Genetic Analysis of Opioid Dose
Demographics Of Chronic Opioid Use PatientsSex n min median max mean sd q25 q75
Age F 4502 18 59 89 583 149 48 69M 2468 21 61 89 60 134 52 69
BMIF 4501 177 318 793 328 866 265 377M 2467 178 312 724 323 778 271 362
Smoker F 2936M 1902
DeceasedF 37M 39
Self-identifiedAncestral Origin
(unknown = 3)
Asian African European Nat American Pacific Islands
9 152 6783 19 4
Analysis restricted to European ancestral origin (defined by genomic analysis) patients with non-progressive musculo-skeletal pain Patient population is older mostly women with a substantial degree of obesity
GWAS of Imputed Genotype and Final Opioid Dose ValuesN=6406 European-American samples Co-variates are sex age age2 BMI
Presenter
Presentation Notes
6406 European samples have all data as well as co-variates sex Age Age2 BMI
GWAS Analysis On Final Dosage Values ndash Top HitsSNP A1 A2 Freq Beta SE Pvalue Z-score GENE Distance
1941502591 C T 0009528 317671 44796 133E-12 70915 CYP2B6 0
1941516446 T G 0010091 292021 435853 208E-11 669999 CYP2B6 0
1941497129 C T 0009916 293249 439189 244E-11 667706 CYP2B6 74
1942508415 C A 0006765 369559 574168 122E-10 643643 GRIK5 0
3160872546 A G 0022316 193055 308107 371E-10 626584 NMD3 0
1941483146 T C 000893 283456 465317 112E-09 609168 CYP2B6 14057
1043311788 G A 0004959 373482 631193 328E-09 591708 BMS1 0
1941490220 G T 0008992 271035 4633 491E-09 58501 CYP2B6 6983
1941494747 A G 0009355 259567 453527 104E-08 57233 CYP2B6 2456
1941493721 G C 0009404 255391 451653 156E-08 565458 CYP2B6 3482
94861936 T A 0010412 241727 43272 232E-08 558622 RCL1 0
1941493931 A G 0009486 251104 449805 237E-08 558251 CYP2B6 3272
13112178960 A G 000759 272639 506748 744E-08 538017 RP11-65D242 61587
369079256 T C 0010249 236531 439786 752E-08 537832 TMF1 0
247780973 T C 0004623 345617 646509 900E-08 53459 KCNK12 0
247780973 T C 0004623 345617 646509 900E-08 53459 MSH2 0
2176006253 T C 0004147 368373 689106 901E-08 534567 ATF2 0
1075042138 C A 0003961 371672 695908 925E-08 534082 TTC18 0
1941519939 G A 001018 231392 434228 989E-08 532881 CYP2B6 0
FASTBAT (Bakshi et al Sci Rep 2016)Nearly all human genes possess a wide array of common and rare variants
It is often the case that more than one variant in a gene increases risk for a phenotype
However many analytic approaches test one variant at a time
FASTBAT uses the ldquogene as the unit of analysisrdquo approach removing variants in high linkage disequilibrium with the index allele
FASTBAT then assesses evidence for association across a pre-specified region (eg 50kb from the 5rsquo amp 3rsquo UTRs of a gene)
FASTBAT has a smaller multiple testing correction than GWAS
Gene-based FastBAT Analysis Manhattan Plot
Gene-based FastBAT Analysis ndash Top HitsGene Chr Start End SNPs ꭕ2 (Obs) P value Top SNP P
value Top SNPCSMD1 8 2742874 4902328 14 114792 402E-17 000060158 83930773ROBO2 3 77039293 77749114 8 818543 199E-10 269E-05 377502696
KIAA1217 10 23933674 24886777 7 590098 257E-10 000071350 1024696221
NTM 11 131E+08 132E+08 5 498785 154E-09 373E-05 11132252245
ERBB4 2 212E+08 213E+08 11 106941 169E-09 246E-06 2213442335CYP2B6 19 41447203 41574301 7 211988 281E-09 245E-10 1941527829STON1 2 48707307 48875654 5 480196 366E-09 000031586 248723124STON1-
GTF2A1L 2 48707063 49053656 5 480196 366E-09 000031586 248723124
ATP1A3 19 42420733 42548428 2 657162 460E-09 122E-10 1942508415GRIK5 19 42452467 42619957 2 657162 460E-09 122E-10 1942508415
RABAC1 19 42410832 42513528 2 657162 460E-09 122E-10 1942508415CCDC3 10 12888624 13191773 2 382889 508E-09 381E-06 1013071690
CNTNAP2 7 146E+08 148E+08 11 108939 512E-09 335E-05 7146270310LRP1B 2 141E+08 143E+08 9 996958 543E-09 611E-05 2141429140GRM7 3 6852801 7833218 9 101038 693E-09 444E-06 37138303USP54 10 75207295 75385433 2 376622 695E-09 245E-07 1075316958DAB1 1 57413578 58766211 6 72748 767E-09 340E-07 157852859BLZF1 1 169E+08 169E+08 2 370416 954E-09 131E-05 1169337581
CCDC181 1 169E+08 169E+08 2 370416 954E-09 131E-05 1169337581NME7 1 169E+08 169E+08 2 370416 954E-09 131E-05 1169337581PTPRD 9 8264245 10662723 9 793552 271E-08 866E-05 99870817
PTPRD Protein Tyrosine Phosphatase Receptor delta (tumor suppressor gene)
28
Ward J et al Genome-wide analysis in UK Biobank identifies four loci associated with mood instability and genetic correlation with major depressive disorder anxiety disorder and schizophrenia Transl Psychiatry 2017 71264
PTPRD alleles associated with mood instability Phenotype is answer to the question Does your mood often go up and downrsquo 53525 cases of mood instability and 60443 controls rs10959826 in PTPRD on chr 9 GA SNP P = 77 times 10minus9
CSMD1 cub and sushi multiple domains 1 (tumor suppressor gene) common alleles are GWAS-significant in schizophrenia
Rare mutations cause familial Parkinsonrsquos Disease
All Opioids CSMD1 amp PTPRD Statistics
Gene SNPs
1st SNP Last SNP χ2 P Top SNP P
CSMD1 14 83121439 84706207 115 4e-17 83930773 6e-4
PTPRD 9 99200806 910554882 79 3e-8 99870817 9e-5
Hg19GRCH37
The opioid crisis is trans-generational
Table 1 NOWS Clinical SignsNOWS emerges 12-72 hours after birth in 55-95 of infantswhose mothers are taking opioids on a daily basis during pregnancy
Common signs high-pitched cry irritability exaggerated reflexes hypertonicitytremors vomiting loose stools poor feeding ineffective sucking failure to thrive sweating temperature instability sneezing nasal congestion inconsolable crying fever
Presenter
Presentation Notes
Kocherlakota P Neonatal abstinence syndrome Pediatrics 2014 134(2) e547-6113Patrick SW Davis MM Lehmann CU Lehman CU Cooper WO Increasing incidence and geographic distribution of neonatal abstinence syndrome United States 2009 to 2012 J Perinatol 2015 35 650-5
Rates of neonatal opioid abstinence
syndrome per 1000 live births
in Philadelphia (report of Mayorrsquos
Task force on Opioid Addiction 2017)
Neonatal Opioid Withdrawal Syndrome (NOWS)
Winkleman et al Pediatrics 2018
Medicaid Hospital Costs for NOWS Neonates
Confidential Dont Share outside Geisinger 34
Australian Study of Cognition in NOWS Children at Ages 9 11 and 13Oei et al Pediatrics 2017
NAPLAN is a national standardized test of reading math spelling grammar Controls were children matched for NOWS group demographics socioeconomic status etc
NOWS Children
Presenter
Presentation Notes
NAPLAN is an Australian national standardized test of readiness for promotion to the next grade in elementary and middle school
Australian NOWS Neonates amp Control Neonates
Plt005 Plt001NOWS Control NOWS vs Controln = 2234 n = 4330
ltlt gtgt
ltlt gtgt
ltlt gtgt
Oei et al Pediatrics 2017
0
2
4
6
8
10
12
14
16
Reading Math Spelling Grammar Writing
14
12
10
6
4
8 yo Children Failing to Meet Minimum National Standards
NOWS
Controls
Oei et al Pediatrics 2017
0
5
10
15
20
25
30
Reading Math Spelling Grammar Writing
25
20
15
10
5
12 yo Children Failing to Meet Minimum National Standards
NOWSControlsOei et al Pediatrics 2017
Figure 2
38
NOWS EHR Analyses by Raghu Metpally PhDIn the years 2011-17 969 babies born at Geisinger were assigned ICD-10 code P961 neonatal withdrawal symptoms from maternal use of drugs of addiction
526 of these patients were seen in the past 2 years at Geisinger
Very little is known about the developmental behavioral and cognitive challenges these individuals encounter as they develop through childhood and adolescence
We wish to access de-identified records of these Geisinger P961 patients and their mothers to determine the types of Geisinger appointments procedures and ICD-10 codes that characterize these patients
We have a longer-term goal to contact these Geisinger P961 patients and their mothers to request their consent to assess them for behavioral cognitive and developmental characteristics
39
ICD10 ICD10_DESCRIPTIONCount 1 call 1 call
O09899Supervision of other high-risk pregnancies unspecified trimester 392 829
Z23 Encounter for immunization 327 691F1120 Opioid dependence uncomplicated 316 6685
O99320Drug use complicating pregnancy unspecified trimester 305 645
Z720 Tobacco use 287 607
Z3480Encounter for supervision of other normal pregnancy unspecified trimester 264 558
F17200 Nicotine dependence unspecified uncomplicated 260 550
O99330Smoking (tobacco) complicating pregnancy unspecified trimester 241 510
O0990Supervision of high-risk pregnancy unspecified unspecified trimester 234 495
Z01419Encounter for gynecological examination (general) (routine) without abnormal findings 222 469
F329 Major depressive disorder single episode unspecified 221 467
ICD10 Codes for Mothers of NOWS Babies at Geisinger (526 infants born to 473 mothers 112007-42019)
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Total1 7 16 29 29 33 52 61 60 72 63 73 30 526
Presenter
Presentation Notes
The bottom panel identified the of NOWS infants born in that calendar year
40
ICD10 ICD10_DESCRIPTIONcount_1call _1call
P961Neonatal withdrawal symptoms from maternal use of drugs of addiction 526 100
J069 Acute upper respiratory infection unspecified 258 4905
B9789Other viral agents as the cause of diseases classified elsewhere 215 4087
L22 Diaper dermatitis 175 3327
P002Newborn affected by maternal infectious and parasitic diseases 170 3232
R05 Cough 123 2338
O98419Viral hepatitis complicating pregnancy unspecified trimester 115 2186
R509 Fever unspecified 115 2186P009 Newborn affected by unspecified maternal condition 112 2129N478 Other disorders of prepuce 111 2110O99320 Drug use complicating pregnancy unspecified trimester 107 2034P599 Neonatal jaundice unspecified 102 1939B182 Chronic viral hepatitis C 98 1863B349 Viral infection unspecified 95 1806B372 Candidiasis of skin and nail 94 1787
ICD10 codes for NOWS Infants at Geisinger 112007-42019(526 infants born to 473 mothers)
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Total1 7 16 29 29 33 52 61 60 72 63 73 30 526
41
Analyses by Karena Moran PhD (NEPaPQC) of EHRRecords 12016 to 92018
672 pregnant women with OUD were identified by ICD-10 codes F1120 O99320 and Z79891 totaling 5 of all infant born at Geisinger in these 30 months
14 of pregnant OUD women received medication-assisted treatment during pregnancy
45 of delivered OUD women kept the postpartum appointment compared to 72 of women without OUD
42
SUMMARY
Risk for OUD is unacceptably high when opioids are prescribed chronically for non-progressive musculo-skeletal pain In our control chart review sample (n=200) 13 of patients had moderate or severe OUD but none of these had an EHR OUD diagnosis
Primary care physicians do not often diagnose OUD in their pain patients who are being treated with opioids over an extended period of time
We must improve efforts to engage pregnant women with OUD in medication-assisted treatment
NOWS children have progressive cognitive deficits which our school systems are ill-equipped to address
AcknowledgementsUniversity of PennsylvaniaRick Crist PhDGlenn Doyle PhDMingyao Li PhD
Rowan University Cooper School of MedicineThomas N Ferraro PhD
Florida Atlantic UniversityJanet Robishaw PhDSarah Palumbo
GeisingerVanessa Troiani PhDRaghu Metpally PhD Kayleigh AdamsonSarah RobishawSarathBabu Krishnamurthy PhDDavid J Carey PhDSarah Pendergrass PhDJoseph Chronowski PhDKarena Moran PhD
Funding Commonwealth of Pennsylvania Department of Health CURE grant (WHB)K01 DA036751 (RC)R01 DA044015 (VT WHB amp JR)
- EHR Characteristics in Opioid Use Disorders
- Topics to be DiscussedRisk for OUD among Geisinger patients with non-progressive musculo-skeletal pain who are prescribed opioids for monthsGenetics of opioid dose at GeisingerNeonatal opioid withdrawal syndrome at Geisinger
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
- Geisinger requires opioid-treated chronic non-progressive pain patients to follow guidelines for opioid use through a Prescription Drug Medication Program (PDMP) including a Medication Use Agreement (MUA take only opioid provided by designated Geisinger MD random UDSs lsquolostrsquo medications will not be replaced minimum twice monthly clinic visits etc) An MUA (site-specific ICD code) is often instituted by the primary care physician if opioid misuse is suspected The MUA is either maintained (PDMP-M) or it is violated and terminated (PDMP-V)
- Slide Number 12
- Slide Number 13
- Slide Number 14
- ICD10 Opioid Use Disorder
- Slide Number 16
- Demographics amp OUD Symptoms in 200 Patients Treated Chronically with Opioids for Non-progressive Pain
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Methods
- Demographics Of Chronic Opioid Use Patients
- GWAS of Imputed Genotype and Final Opioid Dose Values
- GWAS Analysis On Final Dosage Values ndash Top Hits
- Slide Number 25
- Gene-based FastBAT Analysis Manhattan Plot
- Gene-based FastBAT Analysis ndash Top Hits
- PTPRD Protein Tyrosine Phosphatase Receptor delta (tumor suppressor gene)
- All Opioids CSMD1 amp PTPRD Statistics
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Neonatal Opioid Withdrawal Syndrome (NOWS)
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Acknowledgements
-
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | p-value | |||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
Topics to be Discussed
Risk for OUD among Geisinger patients with non-progressive musculo-skeletal pain who are prescribed opioids for months
Genetics of opioid dose at Geisinger
Neonatal opioid withdrawal syndrome at Geisinger
~40-50 years ago research (see for example Marks amp Sachar 1973) indicated that physicians were too restrictive in prescribing opioids for severe pain resulting in undue suffering
But beginning ~30 years ago a few pharmaceutical companies (Purdue) distributed widely to physicians poorly designed studies which seemed to indicate that risk for addiction was negligible if opioids were given for chronic non-progressive pain
The resulting increase in opioid prescriptions has led (predictably) to a large increase in opioid addiction
New England Journal of Medicine 302 123 1980
In the 1990s physicians began to prescribe opioids for non-progressive musculo-skeletal pain leading to increases in OUD
Opioids are very good for acute pain they should not be used forchronic pain due to side effects tolerance and risk for OUD
Presenter
Presentation Notes
This letter to the editor was widely distributed to physicians (by a few pharmaceutical companies) as strong evidence that opioids could be prescribed for chronic pain with little risk for addiction
JAMA 2018
OUD Epidemiology in 6 Healthcare Systems
Lapham G et alDrug Alc Dep 2020
OUD Patients Treated with Buprenorphine
Lapham G et al Drug Alc Dep 2020
Clinical Enterprise14 hospitals~70 community practices 2 million patientsEPIC EHR since 1996Standardized diagnostics DNA amp biofluids bank (MyCode)Accredited medical schoolPatient PopulationStable NE PA population97 European ancestryEngaged patientsWhole exome sequencing amp array genotyping of patient population in progress 145Ksamples completed
Geisinger An Integrated Health Care Delivery System
Patient consent occurs during an outpatient visitConsent creates order for a research blood tube to be drawn at next clinically-indicated phlebotomyRe-contact allowed for return of medically-actionable results from DNA sequencing amp for research purposesgt300000 patient participants
Geisinger Biobank (MyCode) Participants 5000+1-5000
PatientsConsented
500-999100-499
50-99 25-491-24
Phila
Scranton
Danville
Opioid Overdose Deaths by PA County in 2016 per 100000 Persons
0
5
10
15
20
25
30
35
40
Lackawanna Schuylkill Columbia Montour Lycoming Luzerne
3950 opioid deaths in PA in 2016 or 31100000 representing a 37 increase over 2015
52 of PA opioid deaths involved fentanyl45 of PA opioid deaths involved heroin
42249 US opioid overdose deaths in 2016
Presenter
Presentation Notes
The recently released 2017 data show a ~20 increase in opioid deaths in PA
Geisinger requires opioid-treated chronic non-progressive pain patients to follow guidelines for opioid use through a Prescription Drug Medication Program (PDMP) including a Medication Use Agreement (MUA take only opioid provided by designated Geisinger MD random UDSs lsquolostrsquo medications will not be replaced minimum twice monthly clinic visits etc)
An MUA (site-specific ICD code) is often instituted by the primary care physician if opioid misuse is suspected The MUA is either maintained (PDMP-M) or it is violated and terminated (PDMP-V)
We hypothesized that PDMP-M and PDMP-V groups would have electronic health record (EHR) evidence of OUD We reviewed 100 PDMP-M 100 PDMP-V and 200 control EHRs from patients treated at least 90 days with opioids (typically for chronic musculo-skeletal non-progressive pain) Patients were matched on age duration of opioid use gender ethnicity (gt95 European ancestry) Patients with metastatic cancer or other types of progressive pain were excluded 11
12
Geisinger Patients Treated with Opioids for gt60 Days for Non-Progressive Musculo-skeletal Pain
MUA TMUA CONTROL
matched fordemographics
Demographics for Chart Review Sampleof PDMP and Control Patients
PDMP Control p-value
Sample DemographicsN 200 200
Male 84 79Female 116 121
Age 4806 (1046) 482 (1073) 895E-01BMI 3087 (802) 3131 (824) 591E-01
Health Record DataMean EHR length in days 407666 (190227) 382926 (184380) 312E-01Mean number of ER visits 1264 (3298) 449 (615) 675E-03
Mean daily MME 5173 (3522) 3577 (1901) 995E-02
612E-01
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
ICD-10 EHR Diagnoses for Chart Review Sample of PDMP and Control Patients
p-value
Description Distinct patient of pts Distinct patient of ptsTotal 200 200Depression 82 41 33 17 114E-07Anxiety disorder 92 46 39 20 302E-08Depression amp Anxiety disorder 52 26 15 8 143E-06Total 200 200Alcohol 7 4 3 2 337E-01Nicotine 85 43 53 27 111E-03Opioid 6 3 0 0 397E-02Other Substance Abuse 9 5 1 1 250E-02
PDMP Control
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
ICD10 Opioid Use Disorder bull Tolerance (not counted if medication is prescribed by MD)bull Withdrawal (ditto)bull More use of opioids than intendedbull Craving for opioidsbull Unsuccessful efforts to cut downbull Spends excessive time in acquisitionbull Activities given up because of usebull Uses despite negative effectsbull Failure to fulfill major role obligationsbull Recurrent use in hazardous situations (eg while driving)bull Continued use despite social or interpersonal problems
Severity judged by numbers of symptoms 2-3 mild 4-6 moderate 7-11 severe
Presenter
Presentation Notes
When the patient is taking opioids chronically for persistent non-progressive musculo-skeletal pain it may be difficult to determine (for example) whether activities are avoided due to opioid use or due to pain Similarly it may be difficult to distinguish between opioid craving for euphoria versus desire for drug due to re-emergence of pain
16
1 2 3 4 5 6 7 8 9 Vocational Interference Due to Drug Use or Pain X X X
Disabled X X X
Was Weaning Described as Unsuccessful or Difficult X
Positive Tox Screen for Opioids other than Prescribed X X X X X
Lost Pills X X
Multiple Opioid Prescribers X X
Multiple Pharmacies X X
Early Prescription Refills X X
Opioid Overdose X X
Substance Abuse X X
Hazardous Situation as Result of Opioid X
Interpersonal or Legal Issues as Result of Opioid X X X
Medical Issues as Result of Opioid X X
Craving X X
Provider Mentioned Drug-seeking behavior X X X X X
DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems
EHR Search Category DSM-5 Criteria for OUD
EHR Search Methodology for DSM-V OUD Symptoms
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
Demographics amp OUD Symptoms in 200 Patients Treated Chronically with Opioids for Non-progressive Pain
(morphine mg equiv)
18
Rates of DSM-VOUD Dx by chart review in the control (n=200) PDMP (n=200)patients
Rates of DSM-VOUD Dx by chart review in the PDMP-M (n=100) and PDMP-V (n=100) patients
13 of control patients have moderate or severe OUD
PDMP Control p-value
Sample Demographics
N 16253 16253
Male 6944 6949 928E-01Female 9309 9304
Age 5188 (137) 50 (1465) 624E-33
BMI 3169 (84) 3145 (837) 963E-03
Health Record Data
Mean EHR length in days 4211 (207376) 2650 (23522) ltE-200
Mean number of ER visits 8552 (1599) 357 (514) 358E-184
Mean daily MME 5174 (782) 4432 (718) 532E-20
Demographics for Entire Sampleof PDMP and Control Patients
EHR Diagnoses for Entire Sampleof PDMP and Control Patients
Alcohol 489 301 137 083 149E-45Nicotine 4760 2929 1523 926 000E+00Opioid 291 179 48 029 741E-40Other Substance Abuse 570 351 106 064 210E-72
Description Distinct patient of pts Distinct patient of pts p-valueTotal 16253 16253Depression 5446 3351 1473 906 000E+00Anxiety disorder 6552 4031 1605 988 000E+00
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
Methods
Genotypes---GWAS array genotypes for common alleles bull Whole exome sequencing (WES) Imputed (1000 Genomes) bull Phenotypes bull Opioid prescription dosage from EHR medication records years 2012-17
gt 90 days of opioid prescribed 90 days max gap among prescriptions (90-90 Rule) Final regular dose Morphine milligram equivalents (MME) Excluded patients with ICD codes for metastatic cancer and hospice Vast majority of patients had non-progressive musculo-skeletal pain 97 of patients had European-American ancestry by DNA analysis
bull Any opioid (oxycodone tramadol hydrocodone most common)Covariates bull Sex Age Age2 Principle Components 1-4 from population substructure analysis
Association Tests bull Mixed Linear Model Association analysis by GCTA + FASTBAT
Discovery set First 90000 Geisinger patients with WESReplication Next 60000 Geisinger patients Million Veteran Program
21
Genetic Analysis of Opioid Dose
Demographics Of Chronic Opioid Use PatientsSex n min median max mean sd q25 q75
Age F 4502 18 59 89 583 149 48 69M 2468 21 61 89 60 134 52 69
BMIF 4501 177 318 793 328 866 265 377M 2467 178 312 724 323 778 271 362
Smoker F 2936M 1902
DeceasedF 37M 39
Self-identifiedAncestral Origin
(unknown = 3)
Asian African European Nat American Pacific Islands
9 152 6783 19 4
Analysis restricted to European ancestral origin (defined by genomic analysis) patients with non-progressive musculo-skeletal pain Patient population is older mostly women with a substantial degree of obesity
GWAS of Imputed Genotype and Final Opioid Dose ValuesN=6406 European-American samples Co-variates are sex age age2 BMI
Presenter
Presentation Notes
6406 European samples have all data as well as co-variates sex Age Age2 BMI
GWAS Analysis On Final Dosage Values ndash Top HitsSNP A1 A2 Freq Beta SE Pvalue Z-score GENE Distance
1941502591 C T 0009528 317671 44796 133E-12 70915 CYP2B6 0
1941516446 T G 0010091 292021 435853 208E-11 669999 CYP2B6 0
1941497129 C T 0009916 293249 439189 244E-11 667706 CYP2B6 74
1942508415 C A 0006765 369559 574168 122E-10 643643 GRIK5 0
3160872546 A G 0022316 193055 308107 371E-10 626584 NMD3 0
1941483146 T C 000893 283456 465317 112E-09 609168 CYP2B6 14057
1043311788 G A 0004959 373482 631193 328E-09 591708 BMS1 0
1941490220 G T 0008992 271035 4633 491E-09 58501 CYP2B6 6983
1941494747 A G 0009355 259567 453527 104E-08 57233 CYP2B6 2456
1941493721 G C 0009404 255391 451653 156E-08 565458 CYP2B6 3482
94861936 T A 0010412 241727 43272 232E-08 558622 RCL1 0
1941493931 A G 0009486 251104 449805 237E-08 558251 CYP2B6 3272
13112178960 A G 000759 272639 506748 744E-08 538017 RP11-65D242 61587
369079256 T C 0010249 236531 439786 752E-08 537832 TMF1 0
247780973 T C 0004623 345617 646509 900E-08 53459 KCNK12 0
247780973 T C 0004623 345617 646509 900E-08 53459 MSH2 0
2176006253 T C 0004147 368373 689106 901E-08 534567 ATF2 0
1075042138 C A 0003961 371672 695908 925E-08 534082 TTC18 0
1941519939 G A 001018 231392 434228 989E-08 532881 CYP2B6 0
FASTBAT (Bakshi et al Sci Rep 2016)Nearly all human genes possess a wide array of common and rare variants
It is often the case that more than one variant in a gene increases risk for a phenotype
However many analytic approaches test one variant at a time
FASTBAT uses the ldquogene as the unit of analysisrdquo approach removing variants in high linkage disequilibrium with the index allele
FASTBAT then assesses evidence for association across a pre-specified region (eg 50kb from the 5rsquo amp 3rsquo UTRs of a gene)
FASTBAT has a smaller multiple testing correction than GWAS
Gene-based FastBAT Analysis Manhattan Plot
Gene-based FastBAT Analysis ndash Top HitsGene Chr Start End SNPs ꭕ2 (Obs) P value Top SNP P
value Top SNPCSMD1 8 2742874 4902328 14 114792 402E-17 000060158 83930773ROBO2 3 77039293 77749114 8 818543 199E-10 269E-05 377502696
KIAA1217 10 23933674 24886777 7 590098 257E-10 000071350 1024696221
NTM 11 131E+08 132E+08 5 498785 154E-09 373E-05 11132252245
ERBB4 2 212E+08 213E+08 11 106941 169E-09 246E-06 2213442335CYP2B6 19 41447203 41574301 7 211988 281E-09 245E-10 1941527829STON1 2 48707307 48875654 5 480196 366E-09 000031586 248723124STON1-
GTF2A1L 2 48707063 49053656 5 480196 366E-09 000031586 248723124
ATP1A3 19 42420733 42548428 2 657162 460E-09 122E-10 1942508415GRIK5 19 42452467 42619957 2 657162 460E-09 122E-10 1942508415
RABAC1 19 42410832 42513528 2 657162 460E-09 122E-10 1942508415CCDC3 10 12888624 13191773 2 382889 508E-09 381E-06 1013071690
CNTNAP2 7 146E+08 148E+08 11 108939 512E-09 335E-05 7146270310LRP1B 2 141E+08 143E+08 9 996958 543E-09 611E-05 2141429140GRM7 3 6852801 7833218 9 101038 693E-09 444E-06 37138303USP54 10 75207295 75385433 2 376622 695E-09 245E-07 1075316958DAB1 1 57413578 58766211 6 72748 767E-09 340E-07 157852859BLZF1 1 169E+08 169E+08 2 370416 954E-09 131E-05 1169337581
CCDC181 1 169E+08 169E+08 2 370416 954E-09 131E-05 1169337581NME7 1 169E+08 169E+08 2 370416 954E-09 131E-05 1169337581PTPRD 9 8264245 10662723 9 793552 271E-08 866E-05 99870817
PTPRD Protein Tyrosine Phosphatase Receptor delta (tumor suppressor gene)
28
Ward J et al Genome-wide analysis in UK Biobank identifies four loci associated with mood instability and genetic correlation with major depressive disorder anxiety disorder and schizophrenia Transl Psychiatry 2017 71264
PTPRD alleles associated with mood instability Phenotype is answer to the question Does your mood often go up and downrsquo 53525 cases of mood instability and 60443 controls rs10959826 in PTPRD on chr 9 GA SNP P = 77 times 10minus9
CSMD1 cub and sushi multiple domains 1 (tumor suppressor gene) common alleles are GWAS-significant in schizophrenia
Rare mutations cause familial Parkinsonrsquos Disease
All Opioids CSMD1 amp PTPRD Statistics
Gene SNPs
1st SNP Last SNP χ2 P Top SNP P
CSMD1 14 83121439 84706207 115 4e-17 83930773 6e-4
PTPRD 9 99200806 910554882 79 3e-8 99870817 9e-5
Hg19GRCH37
The opioid crisis is trans-generational
Table 1 NOWS Clinical SignsNOWS emerges 12-72 hours after birth in 55-95 of infantswhose mothers are taking opioids on a daily basis during pregnancy
Common signs high-pitched cry irritability exaggerated reflexes hypertonicitytremors vomiting loose stools poor feeding ineffective sucking failure to thrive sweating temperature instability sneezing nasal congestion inconsolable crying fever
Presenter
Presentation Notes
Kocherlakota P Neonatal abstinence syndrome Pediatrics 2014 134(2) e547-6113Patrick SW Davis MM Lehmann CU Lehman CU Cooper WO Increasing incidence and geographic distribution of neonatal abstinence syndrome United States 2009 to 2012 J Perinatol 2015 35 650-5
Rates of neonatal opioid abstinence
syndrome per 1000 live births
in Philadelphia (report of Mayorrsquos
Task force on Opioid Addiction 2017)
Neonatal Opioid Withdrawal Syndrome (NOWS)
Winkleman et al Pediatrics 2018
Medicaid Hospital Costs for NOWS Neonates
Confidential Dont Share outside Geisinger 34
Australian Study of Cognition in NOWS Children at Ages 9 11 and 13Oei et al Pediatrics 2017
NAPLAN is a national standardized test of reading math spelling grammar Controls were children matched for NOWS group demographics socioeconomic status etc
NOWS Children
Presenter
Presentation Notes
NAPLAN is an Australian national standardized test of readiness for promotion to the next grade in elementary and middle school
Australian NOWS Neonates amp Control Neonates
Plt005 Plt001NOWS Control NOWS vs Controln = 2234 n = 4330
ltlt gtgt
ltlt gtgt
ltlt gtgt
Oei et al Pediatrics 2017
0
2
4
6
8
10
12
14
16
Reading Math Spelling Grammar Writing
14
12
10
6
4
8 yo Children Failing to Meet Minimum National Standards
NOWS
Controls
Oei et al Pediatrics 2017
0
5
10
15
20
25
30
Reading Math Spelling Grammar Writing
25
20
15
10
5
12 yo Children Failing to Meet Minimum National Standards
NOWSControlsOei et al Pediatrics 2017
Figure 2
38
NOWS EHR Analyses by Raghu Metpally PhDIn the years 2011-17 969 babies born at Geisinger were assigned ICD-10 code P961 neonatal withdrawal symptoms from maternal use of drugs of addiction
526 of these patients were seen in the past 2 years at Geisinger
Very little is known about the developmental behavioral and cognitive challenges these individuals encounter as they develop through childhood and adolescence
We wish to access de-identified records of these Geisinger P961 patients and their mothers to determine the types of Geisinger appointments procedures and ICD-10 codes that characterize these patients
We have a longer-term goal to contact these Geisinger P961 patients and their mothers to request their consent to assess them for behavioral cognitive and developmental characteristics
39
ICD10 ICD10_DESCRIPTIONCount 1 call 1 call
O09899Supervision of other high-risk pregnancies unspecified trimester 392 829
Z23 Encounter for immunization 327 691F1120 Opioid dependence uncomplicated 316 6685
O99320Drug use complicating pregnancy unspecified trimester 305 645
Z720 Tobacco use 287 607
Z3480Encounter for supervision of other normal pregnancy unspecified trimester 264 558
F17200 Nicotine dependence unspecified uncomplicated 260 550
O99330Smoking (tobacco) complicating pregnancy unspecified trimester 241 510
O0990Supervision of high-risk pregnancy unspecified unspecified trimester 234 495
Z01419Encounter for gynecological examination (general) (routine) without abnormal findings 222 469
F329 Major depressive disorder single episode unspecified 221 467
ICD10 Codes for Mothers of NOWS Babies at Geisinger (526 infants born to 473 mothers 112007-42019)
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Total1 7 16 29 29 33 52 61 60 72 63 73 30 526
Presenter
Presentation Notes
The bottom panel identified the of NOWS infants born in that calendar year
40
ICD10 ICD10_DESCRIPTIONcount_1call _1call
P961Neonatal withdrawal symptoms from maternal use of drugs of addiction 526 100
J069 Acute upper respiratory infection unspecified 258 4905
B9789Other viral agents as the cause of diseases classified elsewhere 215 4087
L22 Diaper dermatitis 175 3327
P002Newborn affected by maternal infectious and parasitic diseases 170 3232
R05 Cough 123 2338
O98419Viral hepatitis complicating pregnancy unspecified trimester 115 2186
R509 Fever unspecified 115 2186P009 Newborn affected by unspecified maternal condition 112 2129N478 Other disorders of prepuce 111 2110O99320 Drug use complicating pregnancy unspecified trimester 107 2034P599 Neonatal jaundice unspecified 102 1939B182 Chronic viral hepatitis C 98 1863B349 Viral infection unspecified 95 1806B372 Candidiasis of skin and nail 94 1787
ICD10 codes for NOWS Infants at Geisinger 112007-42019(526 infants born to 473 mothers)
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Total1 7 16 29 29 33 52 61 60 72 63 73 30 526
41
Analyses by Karena Moran PhD (NEPaPQC) of EHRRecords 12016 to 92018
672 pregnant women with OUD were identified by ICD-10 codes F1120 O99320 and Z79891 totaling 5 of all infant born at Geisinger in these 30 months
14 of pregnant OUD women received medication-assisted treatment during pregnancy
45 of delivered OUD women kept the postpartum appointment compared to 72 of women without OUD
42
SUMMARY
Risk for OUD is unacceptably high when opioids are prescribed chronically for non-progressive musculo-skeletal pain In our control chart review sample (n=200) 13 of patients had moderate or severe OUD but none of these had an EHR OUD diagnosis
Primary care physicians do not often diagnose OUD in their pain patients who are being treated with opioids over an extended period of time
We must improve efforts to engage pregnant women with OUD in medication-assisted treatment
NOWS children have progressive cognitive deficits which our school systems are ill-equipped to address
AcknowledgementsUniversity of PennsylvaniaRick Crist PhDGlenn Doyle PhDMingyao Li PhD
Rowan University Cooper School of MedicineThomas N Ferraro PhD
Florida Atlantic UniversityJanet Robishaw PhDSarah Palumbo
GeisingerVanessa Troiani PhDRaghu Metpally PhD Kayleigh AdamsonSarah RobishawSarathBabu Krishnamurthy PhDDavid J Carey PhDSarah Pendergrass PhDJoseph Chronowski PhDKarena Moran PhD
Funding Commonwealth of Pennsylvania Department of Health CURE grant (WHB)K01 DA036751 (RC)R01 DA044015 (VT WHB amp JR)
- EHR Characteristics in Opioid Use Disorders
- Topics to be DiscussedRisk for OUD among Geisinger patients with non-progressive musculo-skeletal pain who are prescribed opioids for monthsGenetics of opioid dose at GeisingerNeonatal opioid withdrawal syndrome at Geisinger
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
- Geisinger requires opioid-treated chronic non-progressive pain patients to follow guidelines for opioid use through a Prescription Drug Medication Program (PDMP) including a Medication Use Agreement (MUA take only opioid provided by designated Geisinger MD random UDSs lsquolostrsquo medications will not be replaced minimum twice monthly clinic visits etc) An MUA (site-specific ICD code) is often instituted by the primary care physician if opioid misuse is suspected The MUA is either maintained (PDMP-M) or it is violated and terminated (PDMP-V)
- Slide Number 12
- Slide Number 13
- Slide Number 14
- ICD10 Opioid Use Disorder
- Slide Number 16
- Demographics amp OUD Symptoms in 200 Patients Treated Chronically with Opioids for Non-progressive Pain
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Methods
- Demographics Of Chronic Opioid Use Patients
- GWAS of Imputed Genotype and Final Opioid Dose Values
- GWAS Analysis On Final Dosage Values ndash Top Hits
- Slide Number 25
- Gene-based FastBAT Analysis Manhattan Plot
- Gene-based FastBAT Analysis ndash Top Hits
- PTPRD Protein Tyrosine Phosphatase Receptor delta (tumor suppressor gene)
- All Opioids CSMD1 amp PTPRD Statistics
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Neonatal Opioid Withdrawal Syndrome (NOWS)
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Acknowledgements
-
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | p-value | |||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
~40-50 years ago research (see for example Marks amp Sachar 1973) indicated that physicians were too restrictive in prescribing opioids for severe pain resulting in undue suffering
But beginning ~30 years ago a few pharmaceutical companies (Purdue) distributed widely to physicians poorly designed studies which seemed to indicate that risk for addiction was negligible if opioids were given for chronic non-progressive pain
The resulting increase in opioid prescriptions has led (predictably) to a large increase in opioid addiction
New England Journal of Medicine 302 123 1980
In the 1990s physicians began to prescribe opioids for non-progressive musculo-skeletal pain leading to increases in OUD
Opioids are very good for acute pain they should not be used forchronic pain due to side effects tolerance and risk for OUD
Presenter
Presentation Notes
This letter to the editor was widely distributed to physicians (by a few pharmaceutical companies) as strong evidence that opioids could be prescribed for chronic pain with little risk for addiction
JAMA 2018
OUD Epidemiology in 6 Healthcare Systems
Lapham G et alDrug Alc Dep 2020
OUD Patients Treated with Buprenorphine
Lapham G et al Drug Alc Dep 2020
Clinical Enterprise14 hospitals~70 community practices 2 million patientsEPIC EHR since 1996Standardized diagnostics DNA amp biofluids bank (MyCode)Accredited medical schoolPatient PopulationStable NE PA population97 European ancestryEngaged patientsWhole exome sequencing amp array genotyping of patient population in progress 145Ksamples completed
Geisinger An Integrated Health Care Delivery System
Patient consent occurs during an outpatient visitConsent creates order for a research blood tube to be drawn at next clinically-indicated phlebotomyRe-contact allowed for return of medically-actionable results from DNA sequencing amp for research purposesgt300000 patient participants
Geisinger Biobank (MyCode) Participants 5000+1-5000
PatientsConsented
500-999100-499
50-99 25-491-24
Phila
Scranton
Danville
Opioid Overdose Deaths by PA County in 2016 per 100000 Persons
0
5
10
15
20
25
30
35
40
Lackawanna Schuylkill Columbia Montour Lycoming Luzerne
3950 opioid deaths in PA in 2016 or 31100000 representing a 37 increase over 2015
52 of PA opioid deaths involved fentanyl45 of PA opioid deaths involved heroin
42249 US opioid overdose deaths in 2016
Presenter
Presentation Notes
The recently released 2017 data show a ~20 increase in opioid deaths in PA
Geisinger requires opioid-treated chronic non-progressive pain patients to follow guidelines for opioid use through a Prescription Drug Medication Program (PDMP) including a Medication Use Agreement (MUA take only opioid provided by designated Geisinger MD random UDSs lsquolostrsquo medications will not be replaced minimum twice monthly clinic visits etc)
An MUA (site-specific ICD code) is often instituted by the primary care physician if opioid misuse is suspected The MUA is either maintained (PDMP-M) or it is violated and terminated (PDMP-V)
We hypothesized that PDMP-M and PDMP-V groups would have electronic health record (EHR) evidence of OUD We reviewed 100 PDMP-M 100 PDMP-V and 200 control EHRs from patients treated at least 90 days with opioids (typically for chronic musculo-skeletal non-progressive pain) Patients were matched on age duration of opioid use gender ethnicity (gt95 European ancestry) Patients with metastatic cancer or other types of progressive pain were excluded 11
12
Geisinger Patients Treated with Opioids for gt60 Days for Non-Progressive Musculo-skeletal Pain
MUA TMUA CONTROL
matched fordemographics
Demographics for Chart Review Sampleof PDMP and Control Patients
PDMP Control p-value
Sample DemographicsN 200 200
Male 84 79Female 116 121
Age 4806 (1046) 482 (1073) 895E-01BMI 3087 (802) 3131 (824) 591E-01
Health Record DataMean EHR length in days 407666 (190227) 382926 (184380) 312E-01Mean number of ER visits 1264 (3298) 449 (615) 675E-03
Mean daily MME 5173 (3522) 3577 (1901) 995E-02
612E-01
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
ICD-10 EHR Diagnoses for Chart Review Sample of PDMP and Control Patients
p-value
Description Distinct patient of pts Distinct patient of ptsTotal 200 200Depression 82 41 33 17 114E-07Anxiety disorder 92 46 39 20 302E-08Depression amp Anxiety disorder 52 26 15 8 143E-06Total 200 200Alcohol 7 4 3 2 337E-01Nicotine 85 43 53 27 111E-03Opioid 6 3 0 0 397E-02Other Substance Abuse 9 5 1 1 250E-02
PDMP Control
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
ICD10 Opioid Use Disorder bull Tolerance (not counted if medication is prescribed by MD)bull Withdrawal (ditto)bull More use of opioids than intendedbull Craving for opioidsbull Unsuccessful efforts to cut downbull Spends excessive time in acquisitionbull Activities given up because of usebull Uses despite negative effectsbull Failure to fulfill major role obligationsbull Recurrent use in hazardous situations (eg while driving)bull Continued use despite social or interpersonal problems
Severity judged by numbers of symptoms 2-3 mild 4-6 moderate 7-11 severe
Presenter
Presentation Notes
When the patient is taking opioids chronically for persistent non-progressive musculo-skeletal pain it may be difficult to determine (for example) whether activities are avoided due to opioid use or due to pain Similarly it may be difficult to distinguish between opioid craving for euphoria versus desire for drug due to re-emergence of pain
16
1 2 3 4 5 6 7 8 9 Vocational Interference Due to Drug Use or Pain X X X
Disabled X X X
Was Weaning Described as Unsuccessful or Difficult X
Positive Tox Screen for Opioids other than Prescribed X X X X X
Lost Pills X X
Multiple Opioid Prescribers X X
Multiple Pharmacies X X
Early Prescription Refills X X
Opioid Overdose X X
Substance Abuse X X
Hazardous Situation as Result of Opioid X
Interpersonal or Legal Issues as Result of Opioid X X X
Medical Issues as Result of Opioid X X
Craving X X
Provider Mentioned Drug-seeking behavior X X X X X
DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems
EHR Search Category DSM-5 Criteria for OUD
EHR Search Methodology for DSM-V OUD Symptoms
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
Demographics amp OUD Symptoms in 200 Patients Treated Chronically with Opioids for Non-progressive Pain
(morphine mg equiv)
18
Rates of DSM-VOUD Dx by chart review in the control (n=200) PDMP (n=200)patients
Rates of DSM-VOUD Dx by chart review in the PDMP-M (n=100) and PDMP-V (n=100) patients
13 of control patients have moderate or severe OUD
PDMP Control p-value
Sample Demographics
N 16253 16253
Male 6944 6949 928E-01Female 9309 9304
Age 5188 (137) 50 (1465) 624E-33
BMI 3169 (84) 3145 (837) 963E-03
Health Record Data
Mean EHR length in days 4211 (207376) 2650 (23522) ltE-200
Mean number of ER visits 8552 (1599) 357 (514) 358E-184
Mean daily MME 5174 (782) 4432 (718) 532E-20
Demographics for Entire Sampleof PDMP and Control Patients
EHR Diagnoses for Entire Sampleof PDMP and Control Patients
Alcohol 489 301 137 083 149E-45Nicotine 4760 2929 1523 926 000E+00Opioid 291 179 48 029 741E-40Other Substance Abuse 570 351 106 064 210E-72
Description Distinct patient of pts Distinct patient of pts p-valueTotal 16253 16253Depression 5446 3351 1473 906 000E+00Anxiety disorder 6552 4031 1605 988 000E+00
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
Figure 1
Flow Chart
Figure 2
Table 1
Table 2
Table 3
Table 4
Table 5
Supp_e_Table1
Supp_e_Table2
Supp_e_Table3
image1png
image2png
image3png
Methods
Genotypes---GWAS array genotypes for common alleles bull Whole exome sequencing (WES) Imputed (1000 Genomes) bull Phenotypes bull Opioid prescription dosage from EHR medication records years 2012-17
gt 90 days of opioid prescribed 90 days max gap among prescriptions (90-90 Rule) Final regular dose Morphine milligram equivalents (MME) Excluded patients with ICD codes for metastatic cancer and hospice Vast majority of patients had non-progressive musculo-skeletal pain 97 of patients had European-American ancestry by DNA analysis
bull Any opioid (oxycodone tramadol hydrocodone most common)Covariates bull Sex Age Age2 Principle Components 1-4 from population substructure analysis
Association Tests bull Mixed Linear Model Association analysis by GCTA + FASTBAT
Discovery set First 90000 Geisinger patients with WESReplication Next 60000 Geisinger patients Million Veteran Program
21
Genetic Analysis of Opioid Dose
Demographics Of Chronic Opioid Use PatientsSex n min median max mean sd q25 q75
Age F 4502 18 59 89 583 149 48 69M 2468 21 61 89 60 134 52 69
BMIF 4501 177 318 793 328 866 265 377M 2467 178 312 724 323 778 271 362
Smoker F 2936M 1902
DeceasedF 37M 39
Self-identifiedAncestral Origin
(unknown = 3)
Asian African European Nat American Pacific Islands
9 152 6783 19 4
Analysis restricted to European ancestral origin (defined by genomic analysis) patients with non-progressive musculo-skeletal pain Patient population is older mostly women with a substantial degree of obesity
GWAS of Imputed Genotype and Final Opioid Dose ValuesN=6406 European-American samples Co-variates are sex age age2 BMI
Presenter
Presentation Notes
6406 European samples have all data as well as co-variates sex Age Age2 BMI
GWAS Analysis On Final Dosage Values ndash Top HitsSNP A1 A2 Freq Beta SE Pvalue Z-score GENE Distance
1941502591 C T 0009528 317671 44796 133E-12 70915 CYP2B6 0
1941516446 T G 0010091 292021 435853 208E-11 669999 CYP2B6 0
1941497129 C T 0009916 293249 439189 244E-11 667706 CYP2B6 74
1942508415 C A 0006765 369559 574168 122E-10 643643 GRIK5 0
3160872546 A G 0022316 193055 308107 371E-10 626584 NMD3 0
1941483146 T C 000893 283456 465317 112E-09 609168 CYP2B6 14057
1043311788 G A 0004959 373482 631193 328E-09 591708 BMS1 0
1941490220 G T 0008992 271035 4633 491E-09 58501 CYP2B6 6983
1941494747 A G 0009355 259567 453527 104E-08 57233 CYP2B6 2456
1941493721 G C 0009404 255391 451653 156E-08 565458 CYP2B6 3482
94861936 T A 0010412 241727 43272 232E-08 558622 RCL1 0
1941493931 A G 0009486 251104 449805 237E-08 558251 CYP2B6 3272
13112178960 A G 000759 272639 506748 744E-08 538017 RP11-65D242 61587
369079256 T C 0010249 236531 439786 752E-08 537832 TMF1 0
247780973 T C 0004623 345617 646509 900E-08 53459 KCNK12 0
247780973 T C 0004623 345617 646509 900E-08 53459 MSH2 0
2176006253 T C 0004147 368373 689106 901E-08 534567 ATF2 0
1075042138 C A 0003961 371672 695908 925E-08 534082 TTC18 0
1941519939 G A 001018 231392 434228 989E-08 532881 CYP2B6 0
FASTBAT (Bakshi et al Sci Rep 2016)Nearly all human genes possess a wide array of common and rare variants
It is often the case that more than one variant in a gene increases risk for a phenotype
However many analytic approaches test one variant at a time
FASTBAT uses the ldquogene as the unit of analysisrdquo approach removing variants in high linkage disequilibrium with the index allele
FASTBAT then assesses evidence for association across a pre-specified region (eg 50kb from the 5rsquo amp 3rsquo UTRs of a gene)
FASTBAT has a smaller multiple testing correction than GWAS
Gene-based FastBAT Analysis Manhattan Plot
Gene-based FastBAT Analysis ndash Top HitsGene Chr Start End SNPs ꭕ2 (Obs) P value Top SNP P
value Top SNPCSMD1 8 2742874 4902328 14 114792 402E-17 000060158 83930773ROBO2 3 77039293 77749114 8 818543 199E-10 269E-05 377502696
KIAA1217 10 23933674 24886777 7 590098 257E-10 000071350 1024696221
NTM 11 131E+08 132E+08 5 498785 154E-09 373E-05 11132252245
ERBB4 2 212E+08 213E+08 11 106941 169E-09 246E-06 2213442335CYP2B6 19 41447203 41574301 7 211988 281E-09 245E-10 1941527829STON1 2 48707307 48875654 5 480196 366E-09 000031586 248723124STON1-
GTF2A1L 2 48707063 49053656 5 480196 366E-09 000031586 248723124
ATP1A3 19 42420733 42548428 2 657162 460E-09 122E-10 1942508415GRIK5 19 42452467 42619957 2 657162 460E-09 122E-10 1942508415
RABAC1 19 42410832 42513528 2 657162 460E-09 122E-10 1942508415CCDC3 10 12888624 13191773 2 382889 508E-09 381E-06 1013071690
CNTNAP2 7 146E+08 148E+08 11 108939 512E-09 335E-05 7146270310LRP1B 2 141E+08 143E+08 9 996958 543E-09 611E-05 2141429140GRM7 3 6852801 7833218 9 101038 693E-09 444E-06 37138303USP54 10 75207295 75385433 2 376622 695E-09 245E-07 1075316958DAB1 1 57413578 58766211 6 72748 767E-09 340E-07 157852859BLZF1 1 169E+08 169E+08 2 370416 954E-09 131E-05 1169337581
CCDC181 1 169E+08 169E+08 2 370416 954E-09 131E-05 1169337581NME7 1 169E+08 169E+08 2 370416 954E-09 131E-05 1169337581PTPRD 9 8264245 10662723 9 793552 271E-08 866E-05 99870817
PTPRD Protein Tyrosine Phosphatase Receptor delta (tumor suppressor gene)
28
Ward J et al Genome-wide analysis in UK Biobank identifies four loci associated with mood instability and genetic correlation with major depressive disorder anxiety disorder and schizophrenia Transl Psychiatry 2017 71264
PTPRD alleles associated with mood instability Phenotype is answer to the question Does your mood often go up and downrsquo 53525 cases of mood instability and 60443 controls rs10959826 in PTPRD on chr 9 GA SNP P = 77 times 10minus9
CSMD1 cub and sushi multiple domains 1 (tumor suppressor gene) common alleles are GWAS-significant in schizophrenia
Rare mutations cause familial Parkinsonrsquos Disease
All Opioids CSMD1 amp PTPRD Statistics
Gene SNPs
1st SNP Last SNP χ2 P Top SNP P
CSMD1 14 83121439 84706207 115 4e-17 83930773 6e-4
PTPRD 9 99200806 910554882 79 3e-8 99870817 9e-5
Hg19GRCH37
The opioid crisis is trans-generational
Table 1 NOWS Clinical SignsNOWS emerges 12-72 hours after birth in 55-95 of infantswhose mothers are taking opioids on a daily basis during pregnancy
Common signs high-pitched cry irritability exaggerated reflexes hypertonicitytremors vomiting loose stools poor feeding ineffective sucking failure to thrive sweating temperature instability sneezing nasal congestion inconsolable crying fever
Presenter
Presentation Notes
Kocherlakota P Neonatal abstinence syndrome Pediatrics 2014 134(2) e547-6113Patrick SW Davis MM Lehmann CU Lehman CU Cooper WO Increasing incidence and geographic distribution of neonatal abstinence syndrome United States 2009 to 2012 J Perinatol 2015 35 650-5
Rates of neonatal opioid abstinence
syndrome per 1000 live births
in Philadelphia (report of Mayorrsquos
Task force on Opioid Addiction 2017)
Neonatal Opioid Withdrawal Syndrome (NOWS)
Winkleman et al Pediatrics 2018
Medicaid Hospital Costs for NOWS Neonates
Confidential Dont Share outside Geisinger 34
Australian Study of Cognition in NOWS Children at Ages 9 11 and 13Oei et al Pediatrics 2017
NAPLAN is a national standardized test of reading math spelling grammar Controls were children matched for NOWS group demographics socioeconomic status etc
NOWS Children
Presenter
Presentation Notes
NAPLAN is an Australian national standardized test of readiness for promotion to the next grade in elementary and middle school
Australian NOWS Neonates amp Control Neonates
Plt005 Plt001NOWS Control NOWS vs Controln = 2234 n = 4330
ltlt gtgt
ltlt gtgt
ltlt gtgt
Oei et al Pediatrics 2017
0
2
4
6
8
10
12
14
16
Reading Math Spelling Grammar Writing
14
12
10
6
4
8 yo Children Failing to Meet Minimum National Standards
NOWS
Controls
Oei et al Pediatrics 2017
0
5
10
15
20
25
30
Reading Math Spelling Grammar Writing
25
20
15
10
5
12 yo Children Failing to Meet Minimum National Standards
NOWSControlsOei et al Pediatrics 2017
Figure 2
38
NOWS EHR Analyses by Raghu Metpally PhDIn the years 2011-17 969 babies born at Geisinger were assigned ICD-10 code P961 neonatal withdrawal symptoms from maternal use of drugs of addiction
526 of these patients were seen in the past 2 years at Geisinger
Very little is known about the developmental behavioral and cognitive challenges these individuals encounter as they develop through childhood and adolescence
We wish to access de-identified records of these Geisinger P961 patients and their mothers to determine the types of Geisinger appointments procedures and ICD-10 codes that characterize these patients
We have a longer-term goal to contact these Geisinger P961 patients and their mothers to request their consent to assess them for behavioral cognitive and developmental characteristics
39
ICD10 ICD10_DESCRIPTIONCount 1 call 1 call
O09899Supervision of other high-risk pregnancies unspecified trimester 392 829
Z23 Encounter for immunization 327 691F1120 Opioid dependence uncomplicated 316 6685
O99320Drug use complicating pregnancy unspecified trimester 305 645
Z720 Tobacco use 287 607
Z3480Encounter for supervision of other normal pregnancy unspecified trimester 264 558
F17200 Nicotine dependence unspecified uncomplicated 260 550
O99330Smoking (tobacco) complicating pregnancy unspecified trimester 241 510
O0990Supervision of high-risk pregnancy unspecified unspecified trimester 234 495
Z01419Encounter for gynecological examination (general) (routine) without abnormal findings 222 469
F329 Major depressive disorder single episode unspecified 221 467
ICD10 Codes for Mothers of NOWS Babies at Geisinger (526 infants born to 473 mothers 112007-42019)
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Total1 7 16 29 29 33 52 61 60 72 63 73 30 526
Presenter
Presentation Notes
The bottom panel identified the of NOWS infants born in that calendar year
40
ICD10 ICD10_DESCRIPTIONcount_1call _1call
P961Neonatal withdrawal symptoms from maternal use of drugs of addiction 526 100
J069 Acute upper respiratory infection unspecified 258 4905
B9789Other viral agents as the cause of diseases classified elsewhere 215 4087
L22 Diaper dermatitis 175 3327
P002Newborn affected by maternal infectious and parasitic diseases 170 3232
R05 Cough 123 2338
O98419Viral hepatitis complicating pregnancy unspecified trimester 115 2186
R509 Fever unspecified 115 2186P009 Newborn affected by unspecified maternal condition 112 2129N478 Other disorders of prepuce 111 2110O99320 Drug use complicating pregnancy unspecified trimester 107 2034P599 Neonatal jaundice unspecified 102 1939B182 Chronic viral hepatitis C 98 1863B349 Viral infection unspecified 95 1806B372 Candidiasis of skin and nail 94 1787
ICD10 codes for NOWS Infants at Geisinger 112007-42019(526 infants born to 473 mothers)
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Total1 7 16 29 29 33 52 61 60 72 63 73 30 526
41
Analyses by Karena Moran PhD (NEPaPQC) of EHRRecords 12016 to 92018
672 pregnant women with OUD were identified by ICD-10 codes F1120 O99320 and Z79891 totaling 5 of all infant born at Geisinger in these 30 months
14 of pregnant OUD women received medication-assisted treatment during pregnancy
45 of delivered OUD women kept the postpartum appointment compared to 72 of women without OUD
42
SUMMARY
Risk for OUD is unacceptably high when opioids are prescribed chronically for non-progressive musculo-skeletal pain In our control chart review sample (n=200) 13 of patients had moderate or severe OUD but none of these had an EHR OUD diagnosis
Primary care physicians do not often diagnose OUD in their pain patients who are being treated with opioids over an extended period of time
We must improve efforts to engage pregnant women with OUD in medication-assisted treatment
NOWS children have progressive cognitive deficits which our school systems are ill-equipped to address
AcknowledgementsUniversity of PennsylvaniaRick Crist PhDGlenn Doyle PhDMingyao Li PhD
Rowan University Cooper School of MedicineThomas N Ferraro PhD
Florida Atlantic UniversityJanet Robishaw PhDSarah Palumbo
GeisingerVanessa Troiani PhDRaghu Metpally PhD Kayleigh AdamsonSarah RobishawSarathBabu Krishnamurthy PhDDavid J Carey PhDSarah Pendergrass PhDJoseph Chronowski PhDKarena Moran PhD
Funding Commonwealth of Pennsylvania Department of Health CURE grant (WHB)K01 DA036751 (RC)R01 DA044015 (VT WHB amp JR)
- EHR Characteristics in Opioid Use Disorders
- Topics to be DiscussedRisk for OUD among Geisinger patients with non-progressive musculo-skeletal pain who are prescribed opioids for monthsGenetics of opioid dose at GeisingerNeonatal opioid withdrawal syndrome at Geisinger
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
- Geisinger requires opioid-treated chronic non-progressive pain patients to follow guidelines for opioid use through a Prescription Drug Medication Program (PDMP) including a Medication Use Agreement (MUA take only opioid provided by designated Geisinger MD random UDSs lsquolostrsquo medications will not be replaced minimum twice monthly clinic visits etc) An MUA (site-specific ICD code) is often instituted by the primary care physician if opioid misuse is suspected The MUA is either maintained (PDMP-M) or it is violated and terminated (PDMP-V)
- Slide Number 12
- Slide Number 13
- Slide Number 14
- ICD10 Opioid Use Disorder
- Slide Number 16
- Demographics amp OUD Symptoms in 200 Patients Treated Chronically with Opioids for Non-progressive Pain
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Methods
- Demographics Of Chronic Opioid Use Patients
- GWAS of Imputed Genotype and Final Opioid Dose Values
- GWAS Analysis On Final Dosage Values ndash Top Hits
- Slide Number 25
- Gene-based FastBAT Analysis Manhattan Plot
- Gene-based FastBAT Analysis ndash Top Hits
- PTPRD Protein Tyrosine Phosphatase Receptor delta (tumor suppressor gene)
- All Opioids CSMD1 amp PTPRD Statistics
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Neonatal Opioid Withdrawal Syndrome (NOWS)
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Acknowledgements
-
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | p-value | |||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
| PDMP-M(16416) | PDMP-V(1398) | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 14866 | 1387 | ||||||||||||||||
| Depression | 4902 | 33 | 591 | 41 | 212E-09 | 3586 | 0078 | (00513 01048) | |||||||||||
| Anxiety disorder | 5896 | 40 | 702 | 49 | 874E-11 | 4209 | 0088 | (00606 01150) | |||||||||||
| Addiction Codes | Total | 14866 | 1387 | ||||||||||||||||
| Alcohol | 424 | 3 | 74 | 5 | 277E-06 | 2197 | 0022 | (00105 00345) | |||||||||||
| Nicotine | 4178 | 28 | 622 | 43 | 413E-32 | 13913 | 0148 | (01211 01747) | |||||||||||
| Opioid | 243 | 2 | 51 | 4 | 443E-07 | 2550 | 0019 | (00087 00288) | |||||||||||
| Other Substance Abuse | 451 | 3 | 130 | 9 | 555E-31 | 13397 | 0059 | (00439 00745) | |||||||||||
| PDMP-M | PDMP-V | t or χ2 (p) | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 14866 | 1387 | ||||||||||||||
| Male | 6327 | 620 | 01019 | 16364 | 17218 | 0022 | (00045 00494) | |||||||||
| Female | 8539 | 767 | ||||||||||||||
| Age | 5233 (1379) | 4718 (1177) | 135E-51 | 156E+01 | 18396 | 52 | (4504 5799) | |||||||||
| BMI | 3180 (844) | 3053 (795) | 104E-08 | 575E+00 | 17637 | 13 | (08374 17040) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4231 (208872) | 4004 (190057) | 198E-05 | 42785 | 17885 | 2267 | (1228 3306) | |||||||||
| Mean number of ER visits | 8309 (1568) | 1108 (1872) | 156E-05 | -434E+00 | 10458 | 28 | (1518 4022) | |||||||||
| Mean daily MME | 520 (8094) | 4879 (3438) | 146E-02 | 244E+00 | 22230 | 32 | (06336 5776) | |||||||||
| Code | ICD 9 | ICD 10 | Diagnosis | |||||||||||
| Psychiatric Codes | ||||||||||||||
| Anxiety | 300 | F419 | Anxiety disorder unspecified | httpwwwicd10datacomConvertF419 | ||||||||||
| Anxiety | 30001 | F410 | Panic disorder [episodic paroxysmal anxiety] without agoraphobia | Red text duplicate coding in other format (black is original) | ||||||||||
| Anxiety | 30002 | F411 | Generalized anxiety disorder | Black text Original numbering in table | ||||||||||
| Anxiety | 30009 | F413 | Other mixed anxiety disorders | Some codes (ICD9) associated to same single ICD 10 (ie F1020) | ||||||||||
| Anxiety | 30009 | F418 | Other specified anxiety disorders | |||||||||||
| Depression | 2963 | F3340 | Major depressive disorder recurrent in remission unspecified | |||||||||||
| Depression | 2963 | F339 | Major depressive disorder recurrent unspecified | |||||||||||
| Depression | 29631 | F330 | Major depressive disorder recurrent mild | |||||||||||
| Depression | 29632 | F331 | Major depressive disorder recurrent moderate | |||||||||||
| Depression | 29633 | F332 | Major depressive disorder recurrent severe without psychotic features | |||||||||||
| Depression | 29634 or 2980 | F333 | Major depressive disorder recurrent severe with psychotic symptoms | |||||||||||
| Depression | 29635 | F3341 | Major depressive disorder recurrent in partial remission | |||||||||||
| Depression | 29636 | F3342 | Major depressive disorder recurrent in full remission | |||||||||||
| Depression | 29699 | F338 | Other recurrent depressive disorders | |||||||||||
| Depression | 311 | F329 | Depressive disorder not elsewhere classified | |||||||||||
| Addiction Codes | ||||||||||||||
| Alcohol | 291 | F10121 | Alcohol abuse with intoxication delirium | |||||||||||
| Alcohol | 291 | F10231 | Alcohol dependence with withdrawal delirium | |||||||||||
| Alcohol | 2913 | F10251 | Alcohol dependence with alcohol-induced psychotic disorder with hallucinations | |||||||||||
| Alcohol | 2914 | F10929 | Alcohol use unspecified with intoxication unspecified | |||||||||||
| Alcohol | 29181 | F10230 | Alcohol dependence with withdrawal uncomplicated | |||||||||||
| Alcohol | 29181 | F10239 | Alcohol dependence with withdrawal unspecified | |||||||||||
| Alcohol | 29189 | F10159 | Alcohol abuse with alcohol-induced psychotic disorder unspecified | |||||||||||
| Alcohol | 29189 | F10288 | Alcohol dependence with other alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1019 | Alcohol abuse with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1029 | Alcohol dependence with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 2919 | F1099 | Alcohol use unspecified with unspecified alcohol-induced disorder | |||||||||||
| Alcohol | 303 | F10229 | Acute alcoholic intoxication in alcoholism unspecified | |||||||||||
| Alcohol | 30301 | F10229 | Acute alcoholic intoxication in alcoholism continuous | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence | |||||||||||
| Alcohol | 3039 | F1020 | Other and unspecified alcohol dependence unspecified | |||||||||||
| Alcohol | 3039 | F1020 | Alcohol dependence uncomplicated | |||||||||||
| Alcohol | 30391 | F1020 | Other and unspecified alcohol dependence continuous | |||||||||||
| Alcohol | 30392 | F1020 | Other and unspecified alcohol dependence episodic | |||||||||||
| Alcohol | 30393 | F1021 | Other and unspecified alcohol dependence in remission | |||||||||||
| Alcohol | 30393 | F1021 | Alcohol dependence in remission | |||||||||||
| Alcohol | 305 | F1010 | Alcohol abuse unspecified | |||||||||||
| Alcohol | 30501 | F1010 | Alcohol abuse continuous | |||||||||||
| Alcohol | 30502 | F1010 | Alcohol abuse episodic | |||||||||||
| Alcohol | 30503 | F1011 | Alcohol abuse in remission | |||||||||||
| Alcohol | 303 or 30301 | F10229 | Alcohol dependence with intoxication unspecified | |||||||||||
| Alcohol | 30300 or 30301 or 30302 or 30303 | F10220 | Alcohol dependence with intoxication uncomplicated | |||||||||||
| Alcohol | 305 or 30501 or 30502 | F1010 | Alcohol abuse uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10120 | Alcohol abuse with intoxication uncomplicated | |||||||||||
| Alcohol | 30500 or 30501 or 30502 | F10129 | Alcohol abuse with intoxication unspecified | |||||||||||
| Nicotine | 29289 | F17218 | Nicotine dependence cigarettes with other nicotine-induced disorders | |||||||||||
| Nicotine | 29289 | F17228 | Nicotine dependence chewing tobacco with other nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17209 | Nicotine dependence unspecified with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17219 | Nicotine dependence cigarettes with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 2929 | F17229 | Nicotine dependence chewing tobacco with unspecified nicotine-induced disorders | |||||||||||
| Nicotine | 3051 | F17200 | Tobacco use disorder | |||||||||||
| Nicotine | 3051 | F17200 | Nicotine dependence unspecified uncomplicated | |||||||||||
| Nicotine | 3051 | F17201 | Nicotine dependence unspecified in remission | |||||||||||
| Nicotine | 3051 | F17210 | Nicotine dependence cigarettes uncomplicated | |||||||||||
| Nicotine | 3051 | F17220 | Nicotine dependence chewing tobacco uncomplicated | |||||||||||
| Nicotine | 3051 | F17290 | Nicotine dependence other tobacco product uncomplicated | |||||||||||
| Nicotine | Does not exist wo 0 at the end | F1721 | Nicotine dependence cigarettes | |||||||||||
| Opioid | 3047 | Combinations of opioid type drug with any other drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30471 | Combinations of opioid type drug with any other drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30473 | Combinations of opioid type drug with any other drug dependence in remission | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3048 | Combinations of drug dependence excluding opioid type drug unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30481 | Combinations of drug dependence excluding opioid type drug continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30482 | Combinations of drug dependence excluding opioid type drug episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 30483 | Combinations of drug dependence excluding opioid type drug in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Opioid | 3055 | F1110 | Opioid abuse unspecified | |||||||||||
| Opioid | 30551 | F1110 | Opioid abuse continuous | |||||||||||
| Opioid | 30552 | F1110 | Opioid abuse episodic | |||||||||||
| Opioid | 30553 | F1111 | Opioid abuse in remission | |||||||||||
| Other Substance Abuse | 292 | F1593 | Other stimulant use unspecified with withdrawal | |||||||||||
| Other Substance Abuse | 292 | F19930 | Other psychoactive substance use unspecified with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 292 | F19939 | Other psychoactive substance use unspecified with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 29211 | F19950 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with delusions | |||||||||||
| Other Substance Abuse | 29212 | F19951 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder with hallucinations | |||||||||||
| Other Substance Abuse | 2922 | F12120 | Cannabis abuse with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 2922 | F15920 | Other stimulant use unspecified with intoxication uncomplicated | |||||||||||
| Other Substance Abuse | 29284 | F1994 | Other psychoactive substance use unspecified with psychoactive substance-induced mood disorder | |||||||||||
| Other Substance Abuse | 29285 | F19982 | Other psychoactive substance use unspecified with psychoactive substance-induced sleep disorder | |||||||||||
| Other Substance Abuse | 29289 | F15959 | Other stimulant use unspecified with stimulant-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 29289 | F19959 | Other psychoactive substance use unspecified with psychoactive substance-induced psychotic disorder unspecified | |||||||||||
| Other Substance Abuse | 2929 | F1219 | Cannabis abuse with unspecified cannabis-induced disorder | |||||||||||
| Other Substance Abuse | 2929 | F1999 | Other psychoactive substance use unspecified with unspecified psychoactive substance-induced disorder | |||||||||||
| Other Substance Abuse | 3041 | F1320 | Sedative hypnotic or anxiolytic dependence unspecified | |||||||||||
| Other Substance Abuse | 30411 | F1320 | Sedative hypnotic or anxiolytic dependence continuous | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 30413 | F1321 | Sedative hypnotic or anxiolytic dependence in remission | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence unspecified | |||||||||||
| Other Substance Abuse | 3042 | F1420 | Cocaine dependence uncomplicated | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 30423 | F1421 | Cocaine dependence in remission | |||||||||||
| Other Substance Abuse | 3043 | F1220 | Cannabis dependence unspecified | |||||||||||
| Other Substance Abuse | 30431 | F1220 | Cannabis dependence continuous | |||||||||||
| Other Substance Abuse | 30433 | F1221 | Cannabis dependence in remission | |||||||||||
| Other Substance Abuse | 3044 | F1520 | Amphetamine and other psychostimulant dependence unspecified | |||||||||||
| Other Substance Abuse | 30441 | F1520 | Amphetamine and other psychostimulant dependence continuous | |||||||||||
| Other Substance Abuse | 30443 | F1521 | Amphetamine and other psychostimulant dependence in remission | |||||||||||
| Other Substance Abuse | 3046 | F1920 | Other specified drug dependence unspecified | |||||||||||
| Other Substance Abuse | 30461 | F1920 | Other specified drug dependence continuous | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other specified drug dependence in remission | |||||||||||
| Other Substance Abuse | 30463 | F1921 | Other psychoactive substance dependence in remission | |||||||||||
| Other Substance Abuse | 3049 | Unspecified drug dependence unspecified | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30491 | Unspecified drug dependence continuous | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30492 | Unspecified drug dependence episodic | These were lumped into F1920 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 30493 | Unspecified drug dependence in remission | These were lumped into F1921 for diagnosis code in ICD 10 | |||||||||||
| Other Substance Abuse | 3052 | F1210 | Cannabis abuse unspecified | |||||||||||
| Other Substance Abuse | 30521 | F1210 or F1290 | Cannabis abuse continuous | |||||||||||
| Other Substance Abuse | 30522 | F1210 or F1290 | Cannabis abuse episodic | |||||||||||
| Other Substance Abuse | 30523 | F1211 | Cannabis abuse in remission | |||||||||||
| Other Substance Abuse | 30533 | F1611 | Hallucinogen abuse in remission | |||||||||||
| Other Substance Abuse | 3054 | F1310 | Sedative hypnotic or anxiolytic abuse unspecified | |||||||||||
| Other Substance Abuse | 30541 | F1310 | Sedative hypnotic or anxiolytic abuse continuous | |||||||||||
| Other Substance Abuse | 30542 | F1310 | Sedative hypnotic or anxiolytic abuse episodic | |||||||||||
| Other Substance Abuse | 3056 | F1410 | Cocaine abuse unspecified | |||||||||||
| Other Substance Abuse | 30561 | F1410 | Cocaine abuse continuous | |||||||||||
| Other Substance Abuse | 30563 | F1411 | Cocaine abuse in remission | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Amphetamine or related acting sympathomimetic abuse unspecified | |||||||||||
| Other Substance Abuse | 3057 | F1510 | Other stimulant abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30573 | F1511 | Amphetamine or related acting sympathomimetic abuse in remission | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Antidepressant type abuse unspecified | |||||||||||
| Other Substance Abuse | 3058 | F1910 | Other psychoactive substance abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3058 | F1990 | Other psychoactive substance use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3059 | F1910 or F1810 | Other mixed or unspecified drug abuse unspecified | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30591 | F1910 or F1810 | Other mixed or unspecified drug abuse continuous | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30592 | F1910 or F1810 | Other mixed or unspecified drug abuse episodic | Double diagnosis code for ICD10 Did you want sepearate inhalant (ICD F1810) v non inhalent (ICD F1910) | ||||||||||
| Other Substance Abuse | 30593 | F1911 or F1811 | Other mixed or unspecified drug abuse in remission | |||||||||||
| Other Substance Abuse | 2920 or 30410 | F13239 | Sedative hypnotic or anxiolytic dependence with withdrawal unspecified | |||||||||||
| Other Substance Abuse | 2920 or 30460 | F19230 | Other psychoactive substance dependence with withdrawal uncomplicated | |||||||||||
| Other Substance Abuse | 3041 or 30411 | F1320 | Sedative hypnotic or anxiolytic dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3043 or 30431 | F1220 | Cannabis dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3044 or 30441 | F1520 | Other stimulant dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3046 or 30461 | F1920 | Other psychoactive substance dependence uncomplicated | |||||||||||
| Other Substance Abuse | 3052 or 30521 or 30522 | F1210 | Cannabis abuse uncomplicated | |||||||||||
| Other Substance Abuse | 30521 or 3052 or 30522 | F1290 | Cannabis use unspecified uncomplicated | |||||||||||
| Other Substance Abuse | 3054 or 30541 or 30542 | F1310 | Sedative hypnotic or anxiolytic abuse uncomplicated | |||||||||||
| Other Substance Abuse | 3056 or 30551 or 30562 | F1410 | Cocaine abuse uncomplicated |
| Table 5 Psychiatric and Addiction Code Summaries for entire opioid-using PDMP and Control population | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 16253 | 16253 | ||||||||||||||||
| Depression | 5446 | 3351 | 1473 | 906 | 000E+00 | 289685 | 02445 | (02360253) | |||||||||||
| Anxiety disorder | 6552 | 4031 | 1605 | 988 | 000E+00 | 400377 | 03044 | (02960313) | |||||||||||
| Depression amp Anxiety disorder | 3434 | 2113 | 663 | 408 | 000E+00 | 214292 | 01705 | (01630178) | |||||||||||
| Addiction Codes | Total | 16253 | 16253 | ||||||||||||||||
| Alcohol | 489 | 301 | 137 | 083 | 149E-45 | 20067 | 00217 | (0018600247) | |||||||||||
| Nicotine | 4760 | 2929 | 1523 | 926 | 000E+00 | 206603 | 01992 | (01910208) | |||||||||||
| Opioid | 291 | 179 | 48 | 029 | 741E-40 | 17458 | 00150 | (0012700172) | |||||||||||
| Other Substance Abuse | 570 | 351 | 106 | 064 | 210E-72 | 32385 | 00286 | (0025400317) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 14 | 009 | 5 | 003 | 338E-02 | 450 | 00006153089 | (000004000119) | |||||||||||
| Table 4 Demographic and Health Record Summary Data for entire opioid-using PDMP and Control population | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 16253 | 16253 | ||||||||||||||
| Male | 6944 | 7 | 928E-01 | -009 | 327420 | 000 | (00102 00112) | |||||||||
| Female | 9309 | 9304 | ||||||||||||||
| Age | 5188 (137) | 50 (1465) | 624E-33 | 1197 | 326330 | 188 | (157 2187) | |||||||||
| BMI | 3169 (84) | 3145 (837) | 963E-03 | 259 | 327380 | 024 | (0058 0422) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 4211 (207376) | 2650 (23522) | 000E+00 | 6318 | 316170 | 156043 | (1512 16084) | |||||||||
| Mean number of ER visits | 8552 (1599) | 357 (514) | 358E-184 | 2939 | 137480 | 499 | (465 531) | |||||||||
| Mean daily MME | 5174 (782) | 4432 (718) | 532E-20 | 917 | 144220 | 741 | (582 899) | |||||||||
| Table 3 Psychiatric and Addiction Code Summaries for Chart Review Subsample | |||||||||||||||||||
| PDMP | Control | p-value | Test Statistic | Effect Size | Confidence Interval | ||||||||||||||
| Code | Description | Distinct patient count | of pts | Distinct patient count | of pts | ||||||||||||||
| Psychiatric Codes | Total | 200 | 200 | ||||||||||||||||
| Depression | 82 | 41 | 33 | 17 | 114E-07 | 2812 | 0245 | (01550335) | |||||||||||
| Anxiety disorder | 92 | 46 | 39 | 20 | 302E-08 | 3069 | 0265 | (017180358) | |||||||||||
| Depression amp Anxiety disorder | 52 | 26 | 15 | 8 | 143E-06 | 2324 | 0185 | (01090261) | |||||||||||
| Addiction Codes | Total | 200 | 200 | ||||||||||||||||
| Alcohol | 7 | 4 | 3 | 2 | 337E-01 | 092 | 0015 | (00160056) | |||||||||||
| Nicotine | 85 | 43 | 53 | 27 | 111E-03 | 1063 | 016 | (00630257) | |||||||||||
| Opioid | 6 | 3 | 0 | 0 | 397E-02 | NA | 003 | (00010059) | |||||||||||
| Other Substance Abuse | 9 | 5 | 1 | 1 | 250E-02 | 503 | 004 | (00050075) | |||||||||||
| Alcohol amp Nicotine amp Opioid amp Other | 0 | 0 | 0 | 0 | NA | NA | NA | NA | |||||||||||
| Table 2 Demographic and Health Record Summary Data for Chart Review Subsample | ||||||||||||||||
| PDMP | Control | p-value | Test Statistics | Degrees of freedom | Effect Size | Confidence Interval | ||||||||||
| Sample Demographics | ||||||||||||||||
| N | 200 | 200 | ||||||||||||||
| Male | 84 | 79 | 612E-01 | -051 | 3980 | 003 | (0072 0122) | |||||||||
| Female | 116 | 121 | ||||||||||||||
| Age | 4806 (1046) | 482 (1073) | 895E-01 | -013 | 3977 | 014 | (194 222) | |||||||||
| BMI | 3087 (802) | 3131 (824) | 591E-01 | -054 | 3977 | 044 | (116 204) | |||||||||
| Health Record Data | ||||||||||||||||
| Mean EHR length in days | 407666 (190227) | 382926 (184380) | 312E-01 | 101 | 3802 | 21079 | (198 620) | |||||||||
| Mean number of ER visits | 1264 (3298) | 449 (615) | 675E-03 | 275 | 1357 | 816 | (229 1401) | |||||||||
| Mean daily MME | 5173 (3522) | 3577 (1901) | 995E-02 | 191 | 67 | 1596 | (397 358) | |||||||||
| Table 1 EHR Search Categories Defined for Identifying DSM-5 Criteria 1-9 | ||||||||||||||||||
| EHR Search Category | DSM-5 Criteria for OUD | |||||||||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||||||||||
| Vocational Interference Due to Drug Use or Pain | X | X | X | |||||||||||||||
| Disabled | X | X | X | |||||||||||||||
| Was Weaning Described as Unsuccessful or Difficult | X | |||||||||||||||||
| Positive Tox Screen for Opioids other than Prescribed | X | X | X | X | X | |||||||||||||
| Lost Pills | X | X | ||||||||||||||||
| Multiple Opioid Prescribers | X | X | ||||||||||||||||
| Multiple Pharmacies | X | X | ||||||||||||||||
| Early Prescription Refills | X | X | ||||||||||||||||
| Opioid Overdose | X | X | ||||||||||||||||
| Substance Abuse | X | X | ||||||||||||||||
| Hazardous Situation as Result of Opioid | X | |||||||||||||||||
| Interpersonal or Legal Issues as Result of Opioid | X | X | X | |||||||||||||||
| Medical Issues as Result of Opioid | X | X | ||||||||||||||||
| Craving | X | X | ||||||||||||||||
| Provider Mentioned Drug-seeking behavior | X | X | X | X | X | |||||||||||||
| DSM-5 Criteria defined as 1 MoreLonger Use of Opioids than Intended 2 Unsuccessful Efforts to Cut Down 3 Time Taken to Obtain or Recover 4 Craving 5 WorkSchool Impact 6 Interpersonal Impact 7 Reduced Activities Because of Use 8 Continued Use When Physically Hazardous and 9 Use Despite PhysicalPsychological Problems | ||||||||||||||||||
