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The One Year Treatment Course of New Opioid Recipients in Veterans Health Administration

Mosher HJ, Richardson KK, Lund BC. The One Year Treatment Course of New Opioid Recipients in Veterans Health Administration. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2016 May 11; Hollywood, FL.


Background: Recent research on patients who are on long term opioid therapy (LTOT) demonstrates that, once established, LTOT tends to be persistent. Little is known about patterns of new opioid prescription leading to long-term therapy. Short term opioid therapy (e.g. for acute pain) is common; it is not known what proportion of patients newly prescribed opioids subsequently has a pattern of ongoing opioid receipt. An understanding of the patterns of opioid receipt leading to long term therapy may improve clinical decision-making regarding repeat prescribing, and inform policy decisions aimed at curtailing excess or inappropriate opioid use. Therefore, our objectives were to describe the one-year treatment course of new opioid recipients, including the proportion that subsequently received opioids long-term; contrast initial prescription characteristics over time (e.g. dose, days supplied); and discern variation in proportion of long-term therapy initiation across Veterans Health Administration (VHA) medical centers. Methods: We included VHA pharmacy users in 2004 and 2011 who received a new opioid prescription preceded by 365 days in which no opioid was prescribed (i.e., new recipients). Short-term therapy was defined as an index treatment episode lasting no longer than 30 days and no additional opioid prescriptions in the year following initiation. Long-term therapy was defined as a treatment episode of > 90 days that occurred within the year following initiation. All other patterns were considered intermediate. Results: In 2004, 43.2% (161,247 / 373,276) of new opioid recipients met the definition of short term therapy, compared to 42.7% (224,939 / 526,499) in 2011. The proportion who met the definition for long-term therapy decreased from 20.4% (76,280) in 2004 to 18.3% (96,166) in 2011. The remaining proportion, patients with intermediate patterns of receipt, increased from 36.4% (135,821) in 2004 to 39.1% (205,394) in 2011. Although initial dose remained stable between 2004 and 2011, median days supplied in the index prescription decreased from 30 to 20 days, and a greater percentage of new opioid recipients received initial prescriptions of 7 days or fewer (20.9% in 2004; 27.9% in 2011). The proportion of new recipients whose therapy continued long-term use ranged from 10.5% to 38.5% across medical centers in 2011. Conclusions: While the overall number of new opioid recipients increased, the proportion who had subsequent long-term opioid therapy declined slightly between 2004 and 2011. This decline may reflect a growing reluctance to initiate long-term opioid therapy or the saturation of potential candidates for long-term opioids. The rising proportion of intermediate users warrants further investigation. Recent initiatives aim to curtail opioid prescribing. Our method of characterizing opioid prescribing distinguishes clinically different short- and long-term patterns, and can be applied to assessing outcomes of efforts such as the national Opioid Safety Initiative.

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