Department of Psychiatry.
Clinical Addiction Research and Education Unit, Boston University School of Medicine, Boston, Massachusetts.
Pain Med. 2019 Jul 1;20(7):1330-1337. doi: 10.1093/pm/pny124.
To identify reasons for opioid discontinuation and post-discontinuation outcomes among patients in the Transforming Opioid Prescribing in Primary Care (TOPCARE) study.
In TOPCARE, an intervention to improve adherence to opioid prescribing guidelines, randomized intervention primary care providers (PCPs) received nurse care manager support, an electronic registry, academic detailing, and electronic tools, and control PCPs received electronic tools only.
Four Boston safety net primary care practices.
Patients in both TOPCARE study arms who discontinued opioid therapy during the trial.
Through chart review, we examined the reason for discontinuation and post-discontinuation outcomes: one or more PCP visits, one or more pain-related emergency department (ED) visits, evidence of opioid use disorder (OUD), and referral for OUD treatment.
Opioid discontinuations occurred in 83/586 (14.2%) intervention and 42/399 (10.5%) control patients (P = 0.09). Among patients who discontinued opioids, 81 (65%) discontinued for misuse, with no difference by group (P = 0.38). Aberrancy in monitoring (e.g., discordant urine drug test results) was the most common type of misuse prompting discontinuation (occurring in (51/83 [61%] of intervention patients vs 19/42 [45%, P = 0.08] of control patients). Intervention patients who discontinued opioids had less PCP follow-up (65% vs 88%, P < 0.01) compared with control patients. We found no differences between groups for pain-related ED visits, evidence of OUD, or OUD treatment referral following discontinuation.
The decreased follow-up among TOPCARE intervention patients who discontinued opioids highlights the need to understand unintended consequences of involuntary opioid discontinuations resulting from interventions to reduce opioid risk.
在转化初级保健中阿片类药物处方（TOPCARE）研究中，确定患者停止使用阿片类药物的原因和停药后的结果。
在 TOPCARE 中，一项旨在提高阿片类药物处方指南依从性的干预措施，随机干预初级保健提供者（PCP）接受护士护理经理支持、电子登记处、学术详细信息和电子工具，而对照组 PCP 仅接受电子工具。
波士顿四个安全网初级保健诊所。
在试验期间停止阿片类药物治疗的 TOPCARE 研究臂中的患者。
干预组和对照组分别有 83/586（14.2%）和 42/399（10.5%）的患者停止使用阿片类药物（P=0.09）。在停止使用阿片类药物的患者中，有 81 人（65%）因滥用而停止使用，两组之间无差异（P=0.38）。监测异常（例如，尿液药物检测结果不一致）是导致停药的最常见滥用类型（发生在干预组的 51/83 [61%]患者和对照组的 19/42 [45%]患者中，P=0.08）。与对照组相比，停止使用阿片类药物的干预组患者接受 PCP 随访的次数较少（65%对 88%，P<0.01）。我们没有发现两组在停药后的疼痛相关急诊就诊、阿片类药物使用障碍的证据或阿片类药物使用障碍治疗转诊方面存在差异。
TOPCARE 干预组中停止使用阿片类药物的患者随访减少，这突出表明需要了解减少阿片类药物风险的干预措施导致的非自愿停止使用阿片类药物的意外后果。
