Use of a prescription opioid registry to examine opioid misuse and overdose in an integrated health system
Open accessAbstract
Strategies are needed to identify at-risk patients for adverse events associated with prescription opioids. This study identified prescription opioid misuse in an integrated health system using electronic health record (EHR) data, and examined predictors of misuse and overdose. The sample included patients from an EHR-based registry of adults who used prescription opioids in 2011 in Kaiser Permanente Northern California, a large integrated health care system. We characterized time-at-risk for opioid misuse and overdose, and used Cox proportional hazard models to model predictors of these events from 2011 to 2014. Among 396,452 patients, 2.7% were identified with opioid misuse and 1044 had an overdose event. Older patients were less likely to meet misuse criteria or have an overdose. Whites were more likely to be identified with misuse, but not to have an overdose. Alcohol and drug disorders were related to higher risk of misuse and overdose, with the exception that marijuana disorder was not related to opioid misuse. Higher daily opioid dosages and benzodiazepine use increased the risk of both opioid misuse and overdose. We characterized several risk factors associated with misuse and overdose using EHR-based data, which can be leveraged relatively quickly to inform preventive strategies to address the opioid crisis.
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Higher opioid use is associated with annual household income below $20,000 in pregnant women in the US.
“Other research on pregnant women in the US have shown similar education gradients and higher opioid use below $20,000 annual household income (55) which is consistent with national data linking lower levels of income to opioid misuse (56).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [55]
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“Dual MHDs are increasingly common among those with OUD (Campbell et al., 2018; Sullivan et al., 2006).”
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“Similarly, in a recent study of an integrated healthcare system that used prescription opioid registry data, higher daily opioid doses were associated with increased risk of opioid misuse (Campbell et al., 2018).”
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Diagnosis and coding of opioid misuse: a systematic scoping review and implementation framework
Hurley, R. W., Bland, K. T., Chaskes, M. D., Hill, E., & Adams, M. C. B. (2025) · Pain medicine (Malden, Mass.) · doi:10.1093/pm/pnaf019 · Cited by 12 · see citing works
“45,53 used the ICD (ICD-9 or ICD-10 or a combination) coding system to identify OM in the administrative database (Table 8).”
InfluentialJones, N. R., Hickman, M., Larney, S., Nielsen, S., Ali, R. L., Murphy, T. J., Dobbins, T., Fiellin, D. A., & Degenhardt, L. J. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108354 · Cited by 11 · see citing works
US national trends in prescription opioid use after burn injury, 2007 to 2017
Polychronopoulou, E., Raji, M. A., Wolf, S. E., & Kuo, Y. (2021) · Surgery · doi:10.1016/j.surg.2020.12.011 · Cited by 11 · see citing works
Hurley, R. W., Bland, K. T., Chaskes, M. D., Guth, D., Hill, E., & Adams, M. C. B. (2025) · Pain Medicine · doi:10.1093/pm/pnaf116 · Cited by 9 · see citing works
Ledlie, S., Tadrous, M., Bayoumi, A. M., McCormack, D., Cheng, C., Besharah, J., Munro, C., & Gomes, T. (2024) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2024.104392 · Cited by 8 · see citing works
Lenert, L. A., Zhu, V. J., Jennings, L. K., McCauley, J. L., Obeid, J. S., Ward, R. C., Hassanpour, S., Marsch, L. A., Hogarth, M. A., Shipman, P., et al. (2022) · JAMIA Open · doi:10.1093/jamiaopen/ooac055 · Cited by 7 · see citing works
“Recent data suggest that a growing proportion of opioid-dependent individuals are initiating use with heroin (or illicit synthetic opioids), rather than prescribed opioids,(9,10) contributing to public health experts’ beliefs that opioid-related OD may continue to increase over the next 1–5 years.(9,10) Patients prese…”
BackgroundHarrison, E., Brant, K., Strong-Jones, S., Skogseth, E. M., Latkin, C. A., & Jones, A. A. (2024) · Psychology of Addictive Behaviors · doi:10.1037/adb0001021 · Cited by 7 · see citing works
Opioid Poisoning and Opioid Use Disorder in Older Trauma Patients
Daoust, R., Paquet, J., Moore, L., Cournoyer, A., Émond, M., Gosselin, S., Lavigne, G. J., Boulanger, A., Mac‐Thiong, J., & Chauny, J. (2020) · Clinical Interventions in Aging · doi:10.2147/cia.s252849 · Cited by 7 · see citing works
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“Co-occurring mental illness has been linked to increased risk for opioid misuse and overdose (Campbell et al., 2018).”
BackgroundRisk factors for opioid addiction in chronic non-cancer pain
López-Arteaga, T., Moreno-Rubio, C., & Mohedano‐Moriano, A. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e19707 · Cited by 4 · see citing works
“Regarding substance use disorder, the literature shows that those with alcohol use (HR: 1.75 95% CI (1.60 – 1.92)) and non-opioid drug disorders (HR: 2.66 CI 95% (2.45 – 2.88)) are more likely to misuse opioids during CNCP [46].”
InfluentialPublic Health Informatics and the Perioperative Physician: Looking to the Future
Mudumbai, S. C., Gabriel, R. A., Howell, S., Tan, J. M., Freundlich, R. E., O’Reilly-Shah, V. N., Kendale, S. M., Poterack, K. A., & Rothman, B. S. (2024) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000006649 · Cited by 4 · see citing works
“…overdoses and also at the patient level during preoperative assessment to detect potential misuse and influence pain management prescriptions 72–74 New York State’s Internet System for Tracking Over-Prescribing (I-STOP) program, for example, includes real-time opioid prescription tracking…”
BackgroundRosenfield, M. N., Beaudoin, F. L., Gaither, R., Hallowell, B. D., Daly, M. M., Marshall, B. D. L., & Chambers, L. C. (2023) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2023.209273 · Cited by 3 · see citing works
Agarwal, I., Joseph, J. W., & Sánchez, L. D. (2022) · Clinical and Experimental Emergency Medicine · doi:10.15441/ceem.22.212 · Cited by 3 · see citing works
Bahji, A., Alemi, M. I., Messier, G. G., & Patten, S. B. (2026) · Cannabis and Cannabinoid Research · doi:10.1177/25785125261437621 · Cited by 2 · see citing works
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Zhang, A., Nyland, J. E., Balles, J. A., Henningfield, M. F., & Zgierska, A. E. (2025) · Justice Evaluation Journal · doi:10.1080/24751979.2025.2473364 · Cited by 1 · see citing works
“…given that mental health conditions commonly co-occur with SUD (Jones & McCance-Katz, 2019) and have been linked to an increased risk of overdose among individuals with SUD (Campbell et al., 2018), and that MAT reduces the harms of OUD, including overdose mortality (Connery, 2015; Ma et al., 2019).”
Tawfik, A. G., Lister, T., Gómez-Lumbreras, A., Peterson, R. T., Bortolato, M., & Malone, D. C. (2025) · American Journal on Addictions · doi:10.1111/ajad.70069 · Cited by 1 · see citing works
“17,24 Overall, this reduces the possibility that the observed effects may represent behavioral alterations related to other mental disorders.”
Horgos, B., Wert, M. J. V., Wiseman, J. F., Wright, J., Gus, E., Markon, K. E., & Rohovit, J. (2025) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-025-09970-2 · Cited by 1 · see citing works
Narváez‐Camargo, M., Mancheño‐Velasco, C., Dacosta‐Sánchez, D., Kvamme, T. L., Hesse, M., & Lozano, O. M. (2025) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-025-01532-z · Cited by 1 · see citing works
“A study focusing on OUD revealed that patients with psychiatric comorbidities face a greater risk of overdose than those without this diagnosis (Campbell et al., 2018).”
Singh‐Tan, S., Jakubowski, A. U., Huxley‐Reicher, Z., Torres‐Lockhart, K., Ceresnak, J., Pacífico, J., Arnsten, J. H., & Southern, W. N. (2026) · Journal of General Internal Medicine · doi:10.1007/s11606-026-10172-5 · Cited by 1 · see citing works
“…based on characteristics investigators theorized might be indicative of more severe OUD and greater health risk: comorbid mental health disorder, 24 elevated Charlson comorbidity index, 25 comorbid substance use disorder, 24,25 discharge diagnosis of opioid poisoning, presence of liver disease,…”
Psychiatric Comorbidities Among Persons Who Are Using Opioids
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Epidemiology: Opioid Use and Related Disorders
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Causas, tratamiento y prevención de la ceguera en el SIDA: la retinitis por citomegalovirus
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“11,12 However, less is known about differences in behavioral health needs among individuals with CP versus those without CP who have OUD and co-occurring mental health disorders.”
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Identifying Pathways between Socioeconomic Factors and Overdose: A Systematic Realist Synthesis
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- Authors
- Campbell, C. I., Bahorik, A. L., VanVeldhuisen, P., Weisner, C., Rubinstein, A. L., & Ray, G. T.
- Affiliations
- Kaiser Permanente (US)
- University of California, San Francisco (US)
- Emmes (United States) (US)
- Kaiser Permanente Santa Rosa Medical Center (US)
- Corresponding author
- Campbell, Cynthia I.
- Venue
- Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2018-05
- Volume
- 110
- Pages
- 31-37
- ISSN
- 0091-7435 (ISSN-L)
- PMC
- PMC6034705
- OpenAlex
- W2794369775
- Cited by
- 63
- References
- 37
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 5 · 2023: 5 · 2022: 4 · 2021: 11 · 2020: 12 · 2019: 11 · 2018: 2
- FWCI
- 8.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Centers for Disease Control and Prevention
- National Institute on Drug Abuse (UG1DA040314)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- prescription opioid misuse, opioid overdose, electronic health records, risk factors, integrated health system, benzodiazepine use, opioid dosage, alcoholism, drug use disorders, opioid epidemic, Kaiser Permanente
- MeSH terms
- Adult, Aged, Aged, 80 and over, Analgesics, Opioid, California, Female, Humans, Male, Middle Aged, Opioid-Related Disorders, Registries, Risk Factors, Electronic Health Records, Drug Overdose, Prescription Drug Misuse
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