Curation and application of diagnosis code listings for surrogate disease states to manage patients at high risk for opioid use disorder

Julie Nguyen, PharmD Candidate 2021
Amber R. Watson, PharmD
Meridith Peratikos, MS

Learning Objectives

1. Upon completion, participant will be able to list significant disease states that can arise as a consequence of intravenous drug use.
2. Upon completion, participant will be able to describe how diagnosis codes of surrogate disease states can be used to recognize potentially undiagnosed opioid use disorder.
3. Upon completion, participant will be able to identify why early recognition of intravenous drug use is important to mitigate further disease development and associated treatment costs.

Session/Poster Description

Despite the escalating opioid overdose epidemic, opioid misuse, abuse, and dependence remain underdiagnosed and underreported in administrative healthcare claims. An analysis of 2017 Medicaid claims data from McKinsey and Company reported that over 80% of patients were at risk for having an
undiagnosed opioid use disorder (OUD). Increased intravenous drug use (IVDU) has been observed in conjunction with the opioid overdose epidemic and has resulted in the spread of infectious diseases. In the absence of a documented OUD diagnosis in administrative claims, the presence of these disease states, in combination with other risk factors, can be indicative of undiagnosed OUD. These surrogate markers for IVDU can provide population health intervention programs with intelligence needed to manage individuals at risk for continued disease progression and worsened outcomes.

This poster will describe the methods used to develop a list of IVDU surrogates from primary literature as well as secondary and tertiary drug information databases. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes matching this list of IVDU surrogate diagnoses were identified and subsequently curated into a reference table. This reference material may be used to identify patients without a documented OUD diagnosis in administrative claims who are in need of
formal assessment for OUD and facilitation into OUD treatment. This poster will also provide descriptive analyses and quantitative insights around these surrogates in a large administrative claims dataset.

Relevance

The information in this poster is derived from an evidence-based literature summary. Tertiary resources (Clinical Pharmacology©, Facts and Comparisons®, IBM Micromedex®, Lexicomp®, The Medical Letter©,
Pharmacist’s LetterTM, and UpToDate®) were searched for the following terms: “intravenous drug abuse,” “opioid,” and “substance abuse.” MEDLINE®, a secondary database, was then queried for the following combinations of Medical Subject Headings (MeSH): [MH Analgesics opioid AND MH Hepatitis C]; [MH Drug users AND MH Substance Abuse, Intravenous AND MH HIV]; [MH Substance Abuse, Intravenous AND MH Analgesics, Opioid; MH Bacteremia; MH Endocarditis; MH Hepatitis B; MH Infectious arthritis; MH Methicillin-resistant Staphylococcus aureus; MH Osteomyelitis; MH Staphylococcus aureus skin infections]. From these results, the most relevant primary literature articles per disease state were selected and summarized. Priority selection was given to systematic reviews and articles with the most recent publication date.

The following IVDU surrogate disease states of interest were identified: amyloidosis, bacteremia, botulism, bone and joint infections (infective arthritis, osteomyelitis), hepatitis (B and C), endophthalmitis, Human Immunodeficiency Virus, infective endocarditis, skin infections (cellulitis, cutaneous abscess), mucormycosis, sepsis, staph infections, tetanus, tuberculosis, and vascular complications (phlebitis, thrombophlebitis, thrombosis). A reference table for ICD-10-CM diagnosis codes for these disease states was then sourced from relevant categories within the Healthcare Cost and Utilization Project Clinical Classification Software.

Relevance to Rx Summit Audience

This poster is relevant to all stakeholders with an interest in methodologies for managing patients with undocumented opioid use disorder in medical claims who are at risk for worsened outcomes due  to adverse effects of intravenous drug use.

Practical Take-Aways

#1. Opioid use disorder can lead to an extensive list of sequelae, which adds to the treatment costs and disease burden of the opioid epidemic.

#2. Surrogate disease states can be utilized as an indirect marker for intravenous drug use to manage patients for better outcomes.

#3. Early recognition of intravenous drug use is important to mitigate further disease development and associated treatment costs.