Impact of Chronic Opioid Therapy Risk Reduction Initiatives on Opioid Overdose

Michael Von Korff; Kathleen Saunders; Sascha Dublin; Rod L Walker; Manu Thakral; Karen J Sherman; Evette J Ludman; Ryan N Hansen; Michael Parchman; Susan M Shortreed

doi:10.1016/j.jpain.2018.08.003

Impact of Chronic Opioid Therapy Risk Reduction Initiatives on Opioid Overdose

J Pain. 2019 Jan;20(1):108-117. doi: 10.1016/j.jpain.2018.08.003. Epub 2018 Sep 3.

Authors

Affiliations

¹ Kaiser Permanente Washington Health Research Institute, Seattle, Washington. Electronic address: vonkorff.m@ghc.org.
² Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
³ Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Departments of Epidemiology, University of Washington, Seattle, Washington.
⁴ Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Departments of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, Washington.
⁵ Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Departments of Pharmacy and Health Services, University of Washington, Seattle, Washington.
⁶ Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Departments of Biostatistics, University of Washington, Seattle, Washington.

PMID: 30189248
DOI: 10.1016/j.jpain.2018.08.003

Abstract

We assessed the effects of opioid dose and risk reduction initiatives on opioid overdose rates among patients on chronic opioid therapy (COT). Using an interrupted time series design, we compared trends in overdose rates. We compared patients on COT in settings that implemented a COT dose reduction initiative and then a COT risk stratification/monitoring initiative to similar patients on COT from control settings. From 2006 to 2014, 31,142 patients on COT (22,673 intervention, 8,469 control) experienced 311 fatal or nonfatal opioid overdoses. In primary analyses, changes in opioid overdose rates among patients on COT did not differ significantly between intervention and control settings with the implementation of either dose reduction or risk stratification/monitoring. In planned secondary analyses, overdose rates decreased significantly (17% per year) during the dose reduction initiative among patients on COT in intervention settings (relative annual change, 0.83; 95% confidence interval, 0.70-0.99), but not in control settings (0.98. 95% confidence interval, 0.70-1.39). We conclude that overdose rates among patients on COT were not decreased by risk stratification and monitoring initiatives. Results were inconsistent for COT dose reduction, with no significant difference between intervention and control settings (primary hypothesis test), but a significant decrease in overdose rates within the intervention setting during dose reduction (secondary hypothesis test). PERSPECTIVE: Risk stratification/monitoring interventions among patients on COT did not decrease opioid overdose rates. The effects of COT dose reduction on opioid overdose rates were inconsistent. Greater decreases in COT dose, a larger control group, or both may have been needed to identify conclusive reductions in opioid overdose rates.

Keywords: Opioids; drug overdose; evaluation; interrupted time series; opioid dose; risk reduction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Analgesics, Opioid / administration & dosage*
Chronic Pain / drug therapy*
Cohort Studies
Drug Overdose / prevention & control*
Drug Prescriptions / standards*
Humans
Physicians, Primary Care / standards*
Practice Guidelines as Topic / standards*
Retrospective Studies
Risk
Risk Reduction Behavior

Substances

Analgesics, Opioid

Grants and funding

T32 AG027677/AG/NIA NIH HHS/United States