Ewha Med J.  2024 Oct;47(4):e63. 10.12771/emj.2024.e63.

Early detection of patients with narcotic use disorder using a modified morphine equivalent daily dose score based on an analysis of real-world prescription patterns: a retrospective cohort study

• Kim YJ
• Lee K

• KMID: 2561414
• DOI: http://doi.org/10.12771/emj.2024.e63

Abstract

Objectives
Addiction to prescription narcotics is a global issue, and detecting individuals with narcotic use disorder (NUD) at an early stage can help prevent narcotics misuse and abuse. We developed a novel index for the early detection of NUD based on an analysis of real-world prescription patterns in a large hospital.
Methods
We analyzed the narcotic prescriptions of 221,887 patients, prescribed by 8,737 doctors from July 2000 to June 2018. To facilitate the early detection of patients at risk of developing NUD after a prolonged period of narcotic use, we developed a weighted morphine equivalent daily dose (wt-MEDD) score. This score was based on the number of prescription dates where the actual MEDD exceeded the intended MEDD. We compared the performance of the wt-MEDD scoring system in identifying patients diagnosed with NUD by doctors against other high-risk NUD indices. These indices included the MEDD scoring system, the number of days on prescribed narcotics, the frequency and duration of prescriptions, narcotics prescriptions from multiple doctors, and the number of early narcotic refills.
Results
A wt-MEDD score cut-off value of 10.5 successfully identified all outliers and diagnosed patients with NUD with 100% sensitivity and 99.6% specificity. This score demonstrated the highest sensitivity and specificity for detecting NUD compared to all other indexes. The predictive performance was further improved by combining the wt-MEDD score with other high-risk NUD indexes.
Conclusion
We developed a novel index, the wt-MEDD score, which showed excellent performance in the early detection of NUD.

Keyword

Narcotic use disorder; Drug abuse detection method; Overlapping MEDD; MEDD ratio

Figure

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  Fig. 1. Schematic diagram of the calculation of the weighted MEDD score. MEDD, morphine equivalent daily dose; wt-MEDD, weighted MEDD.

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  Fig. 2. Flowchart of patient screening and enrollment. ICD, International Classification of Diseases; CDW, clinical data warehouse; EMR, electronic medical records.

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  Fig. 3. Outlier doctors for the weighted morphine equivalent daily dose score in various departments.

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  Fig. 4. Temporal changes in various NUD high risk indices for patients diagnosed with NUD. (A) wt-MEDD, (B) highest actual and intended MEDD every 3 months, (C) highest prescription days every 3 months, (D) total number of prescriptions every 3 months, (E) total number of prescribing doctors every 3 months, (F) number of early receipt of narcotics before ≥7 days for every 3 months. MEDD, morphine equivalent; wt-MEDD, weighted MEDD; NUD, narcotic use disorder.

Reference

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