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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3065 — Adherence to Clinical Guidelines for the Use of Chronic Opioid Therapy in Veterans with Chronic Pain Based on Substance Use Disorder Status

Morasco BJ (Portland VA Medical Center), Duckart JP (Portland VA Medical Center), Dobscha SK (Portland VA Medical Center)

Objectives:
There are little data available about adherence to opioid treatment guidelines for chronic non-cancer pain (CNCP). Given the high rates of CNCP among patients with substance use disorders (SUD), and need for more intensive treatment in SUD patients, we evaluated the extent to which veterans with CNCP and past-year SUD receive treatment consistent with chronic opioid therapy guidelines.

Methods:
Administrative data were collected from veterans with CNCP receiving treatment within a VA regional healthcare network who were prescribed chronic opioid therapy (n = 5,814) from 2008-2009. Generalized estimating equations were used to assess likelihood of adherence to treatment guidelines based on SUD status.

Results:
Twenty percent of CNCP patients prescribed chronic opioid therapy had a past-year SUD diagnosis. Significant differences existed between veterans with and without a past-year SUD diagnosis on demographic characteristics, pain diagnoses, and psychiatric comorbidity. After controlling for healthcare facility, demographic characteristics, and clinical factors, patients with a past-year SUD diagnosis were more likely to have had a mental health therapy session (OR = 1.49, 95% CI = 1.26–1.77) and to have been administered a urine drug screen (UDS) (OR = 2.74, 95% CI = 2.40–3.14). However, only 52% of patients with past-year SUD diagnoses had a UDS administered. There were no significant differences between the two groups on other treatment guideline indicators, including more intensive treatment in primary care, receiving long-acting opioids, participating in physical therapy, or receiving prescriptions for antidepressants.

Implications:
CNCP patients with comorbid SUDs who are prescribed opioids long-term are more likely to participate in mental health therapy and receive UDS monitoring. They were no more likely than patients without a past-year SUD diagnosis to participate in other aspects of pain care. Given prior data indicating patients with comorbid SUD need more intensive treatment to have improvements in pain-related function, they remain at risk for under-treatment of pain.

Impacts:
Although CNCP patients with a past-year SUD diagnosis who are prescribed opioids long-term may need more intensive and supplementary treatment to have improvements in pain-related function, data from this study indicates there are not markedly different treatment approaches in usual care for CNCP based on SUD status.


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