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

Hilary J Mosher; Kelly K Richardson; Brian C Lund

doi:10.1093/pm/pnw058

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

Pain Med. 2016 Jul 1;17(7):1282-1291. doi: 10.1093/pm/pnw058.

Authors

Hilary J Mosher^{1

2}, Kelly K Richardson¹, Brian C Lund^{1

3}

Affiliations

¹ *Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Health Care System, Iowa City, Iowa.
² The Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, Iowa.
³ Department of Epidemiology, University of Iowa, College of Public Health, Iowa City, Iowa, USA.

PMID: 27048346
DOI: 10.1093/pm/pnw058

Abstract

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.

Keywords: Chronic Non-Cancer Pain; Incidence; Opioids; Prevalence; Veterans.

Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US.