Journal article
Decline in Prescription Opioids Attributable to Decreases in Long-Term Use: A Retrospective Study in the Veterans Health Administration 2010-2016
Journal of general internal medicine : JGIM, Vol.33(6), pp.818-824
06/2018
DOI: 10.1007/s11606-017-4283-8
PMCID: PMC5975137
PMID: 29380212
Abstract
Improved understanding of temporal trends in short- and long-term opioid prescribing may inform efforts to curb the opioid epidemic.
To characterize the prevalence of short- and long-term opioid prescribing in the Veterans Health Administration (VHA) from 2010 to 2016.
Observational cohort study using VHA databases.
All patients receiving at least one outpatient prescription through the VHA during calendar years 2010 through 2016.
Prevalence of opioid use from 2010 through 2016, stratified by short-term, intermediate-term, and long-term use. Temporal trends in discontinuation among existing long-term users and initiation of new long-term use and the net impact on rates of long-term opioid use. Relative likelihood of transitioning to long-term opioid use contrasted with use patterns in the prior year.
The prevalence of opioid prescribing was 20.8% in 2010, peaked at 21.2% in 2012, and declined annually to 16.1% in 2016. Between 2010 and 2016, reductions in long-term opioid prescribing accounted for 83% of the overall decline in opioid prescription fills. Comparing data from 2010-2011 to data from 2015-2016, declining rates in new long-term use accounted for more than 90% of the decreasing prevalence of long-term opioid use in the VHA, whereas increases in cessation among existing long-term users accounted for less than 10%. The relative risk of transitioning to long-term use during 2016 was 6.5 (95% CI: 6.4, 6.7) among short-term users and 35.5 (95% CI: 34.8, 36.3) among intermediate users, relative to patients with no opioid prescriptions filled during 2015.
Opioid prescribing trends followed similar trajectories in VHA and non-VHA settings, peaking around 2012 and subsequently declining. However, changes in long-term opioid prescribing accounted for most of the decline in the VHA. Recent VA opioid initiatives may be preventing patients from initiating long-term use. This may offer valuable lessons generalizable to other healthcare systems.
Details
- Title: Subtitle
- Decline in Prescription Opioids Attributable to Decreases in Long-Term Use: A Retrospective Study in the Veterans Health Administration 2010-2016
- Creators
- Katherine Hadlandsmyth - Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, IA, USAHilary Mosher - Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USAMark W Vander Weg - Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USABrian C Lund - Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA. brian.lund@va.gov
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.33(6), pp.818-824
- DOI
- 10.1007/s11606-017-4283-8
- PMID
- 29380212
- PMCID
- PMC5975137
- NLM abbreviation
- J Gen Intern Med
- ISSN
- 1525-1497
- eISSN
- 1525-1497
- Publisher
- United States
- Language
- English
- Date published
- 06/2018
- Academic Unit
- Psychiatry; Epidemiology; Psychological and Brain Sciences; Anesthesia; Injury Prevention Research Center; General Internal Medicine; Community and Behavioral Health; Internal Medicine
- Record Identifier
- 9984006345102771
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