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The 1-Year Treatment Course of New Opioid Recipients in Veterans Health Administration.

Mosher HJ, Richardson KK, Lund BC. The 1-Year Treatment Course of New Opioid Recipients in Veterans Health Administration. Pain medicine (Malden, Mass.). 2016 Jul 1; 17(7):1282-1291.

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BACKGROUND: Understanding opioid prescribing trends requires differentiating clinically distinct short- and long-term receipt patterns. OBJECTIVES: Describe the one-year course of opioid receipt among new opioid recipients and determine the proportion with subsequent long-term opioid therapy. Discern variation in proportion with long-term therapy initiation by geographic region and across Veterans Health Administration (VHA) medical centers. METHODS: Longitudinal course of opioid receipt was analyzed using a cabinet supply approach. Short-term receipt was defined as index treatment episode lasting no longer than 30 days; long-term therapy as treatment episode of? > 90 days that began within the first 30 days following opioid index date. PATIENTS: All VHA pharmacy users in 2004 and to 2011 who received a new prescription for an opioid (incident opioid recipients) preceded by 365 days with no opioid prescribed. RESULTS: The proportion of all incident recipients who met the definition for long-term therapy within the first year decreased from 20.4% (N? = 76,280) in 2004 to 18.3% (N? = 96,166) in 2011. The proportion of incident recipients with chronic pain was unchanged between 2004 and 2011. Hydrocodone and tramadol increased as a proportion of initial opioids prescribed. Median days initially supplied decreased from 30 to 20 days. A greater percentage of new opioid prescriptions were for 7 days or fewer (20.9% in 2004; 27.9% in 2011). The proportion of new recipients who initiated long-term opioid therapy varied widely by medical center. Medical centers with higher proportions of new long-term recipients in 2004 saw greater decreases in this metric by 2011. CONCLUSION: The proportion of new opioid recipients who initiated long-term opioid therapy declined between 2004 and 2011.

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