Corey J Hayes1,2, Erin E Krebs3,4, Chenghui Li5, Joshua Brown6, Teresa Hudson1,2, Bradley C Martin6. 1. Division of Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA. 2. Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA. 3. Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA. 4. Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA. 5. Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA. 6. Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
Abstract
BACKGROUND AND AIM: Prescribers are commonly confronted with discontinuing opioid therapy among patients prescribed chronic opioid therapy (COT). This study aimed to measure the association between discontinuing COT and diagnoses of substance use disorders (SUDs) and opioid-related adverse outcomes (AOs). DESIGN: Retrospective cohort study. SETTING: United States Veterans Healthcare Administration. PARTICIPANTS: Veterans with chronic pain on COT who discontinued opioid therapy were compared with those continuing COT using data from fiscal years 2009 to 2015. MEASUREMENTS: Newly diagnosed substance use disorders (SUD composite; individual types: opioid, non-opioid drug and alcohol use disorders) and opioid-related adverse outcomes (AO composite; individual types: accidents resulting in wounds/injuries, opioid-related accidents/overdoses, alcohol and non-opioid medication-related accidents/overdoses, self-inflicted injuries and violence-related injuries) were evaluated. Primary analyses were conducted using 1:1 matching of discontinuers with those continuing COT based on propensity score and index date (±180-day window). Sensitivity analyses were conducted using logistic regressions with stabilized inverse probability of treatment weighting (SIPTW) and instrumental variable (IV) models. FINDINGS: A total of 15 695 (75.4%) and 17 337 (76.6%) discontinuers were matched with those continuing COT among the cohorts testing SUD and AO development respectively. In the primary propensity score matched analyses, the composite SUD outcome was not different between discontinuers and those continuing COT (OR = 0.932, 95% CI = 0.850, 1.022). The composite AO outcome was lower among discontinuers (OR = 0.660, 95% CI = 0.623, 0.699) compared with those continuing COT. SIPTW analyses found lower SUD (OR = 0.789, 95% CI = 0.743, 0.837), and AO (OR = 0.660, 95% CI = 0.623, 0.699) rates among discontinuers. IV models found mixed and sometimes contradictory results. CONCLUSIONS: Discontinuing patients from chronic opioid therapy appears to be associated with decreased diagnoses for opioid-related adverse outcomes. The association with substance use disorders appears to be inconclusive.
BACKGROUND AND AIM: Prescribers are commonly confronted with discontinuing opioid therapy among patients prescribed chronic opioid therapy (COT). This study aimed to measure the association between discontinuing COT and diagnoses of substance use disorders (SUDs) and opioid-related adverse outcomes (AOs). DESIGN: Retrospective cohort study. SETTING: United States Veterans Healthcare Administration. PARTICIPANTS: Veterans with chronic pain on COT who discontinued opioid therapy were compared with those continuing COT using data from fiscal years 2009 to 2015. MEASUREMENTS: Newly diagnosed substance use disorders (SUD composite; individual types: opioid, non-opioid drug and alcohol use disorders) and opioid-related adverse outcomes (AO composite; individual types: accidents resulting in wounds/injuries, opioid-related accidents/overdoses, alcohol and non-opioid medication-related accidents/overdoses, self-inflicted injuries and violence-related injuries) were evaluated. Primary analyses were conducted using 1:1 matching of discontinuers with those continuing COT based on propensity score and index date (±180-day window). Sensitivity analyses were conducted using logistic regressions with stabilized inverse probability of treatment weighting (SIPTW) and instrumental variable (IV) models. FINDINGS: A total of 15 695 (75.4%) and 17 337 (76.6%) discontinuers were matched with those continuing COT among the cohorts testing SUD and AO development respectively. In the primary propensity score matched analyses, the composite SUD outcome was not different between discontinuers and those continuing COT (OR = 0.932, 95% CI = 0.850, 1.022). The composite AO outcome was lower among discontinuers (OR = 0.660, 95% CI = 0.623, 0.699) compared with those continuing COT. SIPTW analyses found lower SUD (OR = 0.789, 95% CI = 0.743, 0.837), and AO (OR = 0.660, 95% CI = 0.623, 0.699) rates among discontinuers. IV models found mixed and sometimes contradictory results. CONCLUSIONS: Discontinuing patients from chronic opioid therapy appears to be associated with decreased diagnoses for opioid-related adverse outcomes. The association with substance use disorders appears to be inconclusive.
Authors: Travis I Lovejoy; Benjamin J Morasco; Michael I Demidenko; Thomas H A Meath; Joseph W Frank; Steven K Dobscha Journal: Pain Date: 2017-03 Impact factor: 6.961
Authors: Jessica J Wyse; Benjamin J Morasco; Steven K Dobscha; Michael I Demidenko; Thomas H A Meath; Travis I Lovejoy Journal: J Opioid Manag Date: 2018 Jul/Aug
Authors: Elizabeth M Oliva; Thomas Bowe; Sara Tavakoli; Susana Martins; Eleanor T Lewis; Meenah Paik; Ilse Wiechers; Patricia Henderson; Michael Harvey; Tigran Avoundjian; Amanuel Medhanie; Jodie A Trafton Journal: Psychol Serv Date: 2017-02
Authors: Piyameth Dilokthornsakul; Gina Moore; Jonathan D Campbell; Robert Lodge; Cathy Traugott; Judy Zerzan; Richard Allen; Robert L Page Journal: J Pain Date: 2015-12-22 Impact factor: 5.820
Authors: Mark J Edlund; Mark A Austen; Mark D Sullivan; Bradley C Martin; James S Williams; John C Fortney; Teresa J Hudson Journal: Pain Date: 2014-08-29 Impact factor: 6.961
Authors: Mark D Sullivan; Mark J Edlund; Ming-Yu Fan; Andrea DeVries; Jennifer Brennan Braden; Bradley C Martin Journal: Pain Date: 2010-06-15 Impact factor: 6.961
Authors: Nicholas Avery; Amy G McNeilage; Fiona Stanaway; Claire E Ashton-James; Fiona M Blyth; Rebecca Martin; Ali Gholamrezaei; Paul Glare Journal: BMJ Date: 2022-04-04