Impact of initiatives to reduce prescription opioid risks on medically attended injuries in people using chronic opioid therapy

Pharmacoepidemiol Drug Saf. 2019 Jan;28(1):90-96. doi: 10.1002/pds.4678. Epub 2018 Oct 30.


Purpose: The purpose of the study is to determine whether initiatives to improve the safety of opioid prescribing decreased injuries in people using chronic opioid therapy (COT).

Methods: We conducted an interrupted time series analysis using data from Group Health (GH), an integrated health care delivery system in the United States. In 2007, GH implemented initiatives which substantially reduced daily opioid dose and increased patient monitoring. Among GH members age 18 or older receiving COT between 2006 and 2014, we compared injury rates for patients in GH's integrated group practice (IGP; exposed to the initiatives) vs patients cared for by contracted providers (not exposed). Injuries were identified using a validated algorithm. We calculated injury incidence during the baseline (preintervention) period from 2006 to 2007; the dose reduction period, 2008 to 2010; and the risk stratification and monitoring period, 2010 to 2014. Using modified Poisson regression, we estimated adjusted relative risks (RRs) representing the relative change per year in injury rates.

Results: Among 21 853 people receiving COT in the IGP and 8260 in contracted care, there were 2679 injuries during follow-up. The baseline injury rate was 1.0% per calendar quarter in the IGP and 0.9% in contracted care. Risk reduction initiatives did not decrease injury rates: Within the IGP, the RR in the dose reduction period was 1.01 (95% CI, 0.95-1.07) and in the risk stratification and monitoring period, 0.99 (95% CI, 0.95-1.04). Injury trends did not differ between the two care settings.

Conclusions: Risk reduction initiatives did not decrease injuries in people using COT.

Keywords: chronic opioid therapy; fractures; guidelines; injuries; opioids; pharmacoepidemiology; risk reduction.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / adverse effects*
  • Chronic Pain / drug therapy*
  • Craniocerebral Trauma / epidemiology*
  • Craniocerebral Trauma / etiology
  • Delivery of Health Care, Integrated / organization & administration
  • Delivery of Health Care, Integrated / standards*
  • Drug Prescriptions / standards
  • Drug Prescriptions / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Health Plan Implementation
  • Humans
  • Incidence
  • Interrupted Time Series Analysis
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / standards*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Program Evaluation
  • United States


  • Analgesics, Opioid