Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, MA, Boston, USA.
Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA.
J Gen Intern Med. 2020 Dec;35(Suppl 3):903-909. doi: 10.1007/s11606-020-06252-9. Epub 2020 Nov 3.
Prior opioid discontinuation studies have focused on one of two characteristics of opioid prescribing, its duration (long term vs not) or dosage (high vs low). Questions remain about the experience of patients with high-dose, long-term opioid therapy (HLOT) prescriptions who are likely to be at the highest risk for adverse events.
We address the following questions among the Veterans Health Administration (VHA) patients receiving HLOT: 1), How has the prevalence of discontinuation of opioids changed over time? 2), How do patient characteristics vary between those who do and do not discontinue? And 3), how does the prevalence of discontinuation vary geographically?
A retrospective observational study of VHA patients with HLOT between fiscal year (FY) 2014 and FY2018.
We identified 1,281,330 patients from VHA outpatient opioid prescription data with at least a 1-day opioid supply between FY2014 and FY2018. We identified and excluded those receiving palliative care or diagnosed with metastatic cancer.
For a given patient and month, a patient having a 3-month moving average of ≥ 90 daily morphine milligram equivalent (MME) was defined as having HLOT. Similarly, we used a three-month average MME of zero as discontinuation.
The prevalence of discontinuation among patients with HLOT increased from 6.3% in FY2014 to 7.8% in FY2018. Across the years, patients who discontinued were younger, less likely to be married, and more likely to have comorbidities related to substance use disorders compared with patients who continued to receive HLOT. Incidence of discontinuation among those with HLOT increased in more than half (64%) of the 129 VHA medical centers.
Prevalence of patients receiving HLOT in the VHA decreased as the incidence of discontinuation increased. Further research is needed to understand the process by which patients are discontinued and to assess the relationship between discontinuation and health outcomes.
先前的阿片类药物停药研究主要集中在阿片类药物处方的两个特征之一，即持续时间（长期与非长期）或剂量（高与低）。对于接受高剂量、长期阿片类药物治疗（HLOT）处方的患者，他们可能面临最高的不良事件风险，仍存在一些问题。
我们在接受 HLOT 的退伍军人健康管理局（VHA）患者中提出以下问题：1），阿片类药物停药的流行率随时间如何变化？2），在停药和不停药的患者之间，患者特征有何不同？3），停药的流行率在地理上如何变化？
一项对 FY2014 至 FY2018 年间 VHA 门诊接受 HLOT 的患者进行的回顾性观察研究。
我们从 VHA 门诊阿片类药物处方数据中确定了 1,281,330 名至少在 FY2014 至 FY2018 年间有 1 天以上阿片类药物供应的患者。我们确定并排除了接受姑息治疗或诊断为转移性癌症的患者。
对于给定的患者和月份，如果患者在三个月的移动平均值中≥90 天吗啡毫克当量（MME），则定义为患有 HLOT。同样，我们将三个月的平均 MME 为零定义为停药。
HLOT 患者停药的流行率从 FY2014 的 6.3%上升到 FY2018 的 7.8%。在整个研究期间，与继续接受 HLOT 的患者相比，停药的患者更年轻、未婚的可能性更小、且更有可能患有与物质使用障碍相关的合并症。在接受 HLOT 的患者中，有超过一半（64%）的 129 个 VHA 医疗中心的停药发生率有所增加。
退伍军人健康管理局接受 HLOT 的患者人数减少，同时停药的发生率增加。需要进一步研究以了解患者停药的过程，并评估停药与健康结果之间的关系。
