{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T10:19:50Z","timestamp":1766571590530,"version":"3.48.0"},"reference-count":22,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA039192"],"award-info":[{"award-number":["R01DA039192"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Opioids are commonly used to manage chronic pain in older adults, despite their well\u2010documented adverse events (AEs) and the potential for additional less well\u2010known risks. Post\u2010marketing surveillance methods applied in real\u2010world settings are essential to monitor AEs. Prescription Sequence Symmetry Analysis (PSSA) is a method that compares medication initiation patterns within individuals and can detect signals of prescribing cascades and drug AEs. This study applied PSSA to Medicare claims data to explore potential AEs following the initiation of long\u2010term opioid therapy (LOT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used Texas\u2010Medicare data to identify adults who initiated LOT (\u2265\u200990 consecutive days) in 2016\u20132019. Prescription sequence symmetry analysis (PSSA) was performed to explore associations between opioids and related adverse events treated by marker drugs. The observation period for sequences of incident marker drug prescriptions was limited to 12\u2009months before and after opioid initiation. Marker drugs were categorized based on the Anatomical Therapeutic Chemical (ATC) Classification System. Adjusted sequence symmetry ratios (aSSR) and 95% confidence intervals were calculated to account for prescribing trend changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 11,233 incident opioid users, we identified incident marker drugs belonging to 145 distinct ATC classes, 36 of which had statistically significant aSSRs. We found signals of increased post\u2010opioid prescriptions related to known opioid AEs (e.g., propulsives, antiemetics, laxatives, naltrexone) and less well\u2010documented associations (antimicrobials, hormones, antiarrhythmics, and antipsychotics).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PSSA applied to administrative claims data effectively identified both expected and potentially underrecognized adverse effects of long\u2010term opioid use. This approach can enhance post\u2010marketing surveillance by uncovering real\u2010world prescribing cascades in older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.70081","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T11:11:02Z","timestamp":1763377862000},"page":"825-830","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prescription Sequence Symmetry Analysis for Detection of Chronic Opioid Use Adverse Event Signals Using Administrative Claims Data"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6126-6465","authenticated-orcid":false,"given":"Efstathia","family":"Polychronopoulou","sequence":"first","affiliation":[{"name":"Office of Biostatistics, School of Public and Population Health University of Texas Medical Branch  Galveston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mukaila A.","family":"Raji","sequence":"additional","affiliation":[{"name":"Division of Geriatrics and Palliative Medicine, Department of Internal Medicine University of Texas Medical Branch  Galveston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong\u2010Fang","family":"Kuo","sequence":"additional","affiliation":[{"name":"Office of Biostatistics, School of Public and Population Health University of Texas Medical Branch  Galveston Texas USA"},{"name":"Department of Biostatistics and Data Science, School of Public and Population Health University of Texas Medical Branch  Galveston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2023.8154"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X1103900405"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","unstructured":"M. R.SpencerandM. F. M. A. M.Garnett \u201cDrug Overdose Deaths in the United States 2002\u20132022 \u201dNCHS Data Brief No 491 (2024).","DOI":"10.15620\/cdc:135849"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr6501e1"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/26335565241237889"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.focus.2023.100175"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afac138"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654\u2010017\u20100281\u20108"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102288\u201014\u201066"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/ph14111091"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.34142"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPC.0b013e3282f5272e"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.7326\/M17\u20101907"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2013.04.050"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiz133"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0205729"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/FJC.0000000000001182"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1210\/er.2009\u20100009"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2023.11.001"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1159\/000492616"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1885"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awq138"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.70081","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T10:14:47Z","timestamp":1766571287000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.70081"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,17]]},"references-count":22,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/phar.70081"],"URL":"https:\/\/doi.org\/10.1002\/phar.70081","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"type":"print","value":"0277-0008"},{"type":"electronic","value":"1875-9114"}],"subject":[],"published":{"date-parts":[[2025,11,17]]},"assertion":[{"value":"2025-06-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}