[Table 2 here]
LTOT rates (see the Supplementary Appendix C for details): LTOT
rates varied substantially across studies, ranging from 0.2%[52] to 57% [45] according
to the definition used, study design and population included,
denominator, calendar year and follow-up window. Studies testing the
impact of different LTOT definitions reported differences in rates
ranging from <1 to 38 percentage points (1.4 to 13-fold
variation within definitions from the same study).[24, 26, 52, 59, 79, 99, 123, 126, 128]
Most commonly, studies reported LTOT rates as a proportion of people
with specified health conditions (67 studies, 53%), followed by people
using opioids (33 studies, 26%). A lower proportion reported rates
among healthcare enrolees (12 studies, 10%), based on the whole
population (4 studies, 3%), or using other denominators (e.g., opioid
fills, 4 studies, 3%). Finally, six studies (5%) reported multiple
rates (e.g. both among people using opioids and the whole population).
Not surprisingly, we observed the lowest rates of LTOT when they related
t the entire eligible jurisdictional population, varying from 0.2% in
Norway [52] to 1.4% in Denmark.[113] LTOT ranged from 0.3%[129] to 35.8% [38] among
people who were opioid-naïve and prevalent use ranged between 1.8%[130] and 43.0%. [22] We
also observed significant variation in estimates when they were
estimated as a proportion of people with specified health conditions;
from 0.5% among young people with CNCP who were opioid-naïve[31] to 26.4% among veterans with CNCP,
irrespective of prior opioid use. [72] LTOT rates
ranged from 2.7% to 32.1% among people with different cancers[27, 42] and 4.0% to 55.4% among people with
infectious diseases. [33, 75] Variations among
people with neuropathy (8.8%-18.8%) [56, 77] and
trauma or injuries (1.1%-29.0%) were also observed.[131, 132] Among people with musculoskeletal
diseases, estimates ranged from ~2.0% for opioid-naïve
people with rheumatoid arthritis [133] to 41.0%
among people with rheumatoid arthritis irrespective of prior opioid use.[30]