Identifying Clinical Risk Factors for Opioid Use Disorder Across a Statewide Research Network
Background
Which patients receiving an opioid prescription go on to develop opioid use disorder, and how soon? Five participating sites of the OneFlorida Clinical Research Consortium contributed records from 2012 through early 2019 for patients with at least one opioid prescription and no prior cancer or opioid use disorder diagnosis. A case was defined by a first diagnosis within twelve months of the initial prescription. The sites differ substantially in baseline prevalence.
Method
Four algorithms addressed different facets of the same question. ODACH fits a site-stratified Cox model for time to diagnosis, letting baseline hazards differ across sites. ODACAT and its heterogeneity-aware variant handle categorical and temporally resolved outcomes. ADAP fits penalized regression across roughly 15,000 patients when candidate predictors are numerous. A heterogeneity-aware inference framework examined the contribution of anxiety and depression specifically.
Main finding
Anxiety, alcohol use disorders, depression, sleep disorders, and other substance-related diagnoses emerged as consistent correlates of opioid use disorder alongside demographic and insurance factors. In the high-dimensional analysis, the variables selected under the distributed penalized model matched those recovered from pooled patient-level data, indicating that the risk profile is stable across the five sites rather than an artifact of any one population.