Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Pharmaceutical Sciences


Pharmacy Practice

First Advisor

Stephen Kogut


Prescription opioid use and misuse poses a significant public health challenge to the United States. In this dissertation we use the three-manuscript format to address some the areas of unmet research. Each manuscript has an abstract, introduction, background, methods, results, discussion, and conclusions sections.

Manuscript 1: We used a retrospective cohort design to examine the association between the patterns of initial prescription opioid use for non-cancer pain and risk of all-cause mortality among an insured opioid-naïve patient population in the U.S. Multivariable Cox regression model was used to estimate the association of initial pattern of opioid use with all-cause mortality, adjusting for baseline covariates to control for confounding. We found that incident chronic opioid use was associated with an increased risk of all-cause mortality that persisted for up to 5 years after the initiation of opioid therapy.

Manuscript 2: We used a cross-sectional study of the Rhode Island Prescription Drug Monitoring Program data to estimate the annual statewide spending for prescription opioids in Rhode Island. A generalized linear model with gamma distribution with a log link function was used to estimate the relative differences in per-patient annual adjusted average opioid prescription cost. We found that in 2015 the annual expenditure for opioid prescriptions in Rhode Island was $44,271,827. Commercial insurance bore the majority of the cost of prescription opioid use, but cost per patient was highest among Medicare beneficiaries.

Manuscript 3: Using the 2015 Prescription Drug Monitoring Programs data for Rhode Island we examined the association between potential prescription opioid misuse and method of prescription opioid payment used. A multivariable log-binomial regression model was used to examine the risk of potential opioid misuse, controlling for sex, age group, type of opioid used, and concurrent benzodiazepine use. We found that patients on chronic opioid therapy who pay for some, but not all, opioid prescriptions in cash could be associated with potential opioid misuse only when the patient has other health insurance coverage.



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