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The database contains information on more than 40 million patients over the period 2004 to 2009 from approximately 100 private-sector health payers representing a large number of commercially insured populations in the U.S.A. Two data sets were used in this study: the CCAE and the Medicare Supplemental Oxygenase and Coordinator of Benefits (COB) database. The CCAE database was used for subjects?selleck chemicals first dispensing date for a 30-day or more supply of a CYP450-metabolized opioid, that is, codeine, fentanyl, hydrocodone, methadone, oxycodone, or tramadol.35 The ICD-9 codes used to identify OA patients were 715.00, 715.04, 715.09, 715.10, 715.11, 715.12, 715.13, 715.14, 715.15, 715.16, 715.17, 715.18, 715.20, 715.21, 715.22, 715.23, 715.24, 715.25, 715.26, 715.27, 715.28, 715.30, 715.31, 715.32, 715.33, 715.34, 715.35, 715.36, 715.37, 715.38, 715.80, 715.89, 715.90, 715.91, 715.92, 715.93, 715.94, 715.95, 715.96, 715.97, and 715.98. The CPT codes for relevant physician office visits include 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99385, 99387, 99395, 99396, 99397, 99402, 99403, and 99404. OA patients were identified from the medical claims databases for the period from January 1, 2004 to December 31, 2008. Included in the study were OA patients who had been prescribed at least a 30-days' supply of a CYP450-metabolized opioid (codeine, fentanyl, hydrocodone, methadone, oxycodone, or tramadol).35 The index opioid was defined as the first opioid prescribed Gefitinib purchase with at least a 30-day supply; the index date was defined as the first dispensing date of that opioid. Data for all prescriptions (including topical and transdermal products) used by the patients were used to identify DDEs. All patients included in the study had continuous enrollment and were eligible for medical and pharmacy benefits during the six months prior to the index date as well as for a six-month observation period following the index date. The study excluded patients with missing enrollment information as well as those with pregnancy claims (ICD-9-CM 761.5x, V22.xx, V72.40, and V2.32) at baseline or during the observation period.