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Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4081 — Use of Pharmacotherapy for Opioid Use Disorders among Veterans Discontinued from Chronic Opioids

Lead/Presenter: Lewei (Allison) Lin, COIN - Ann Arbor
All Authors: Lin LA (HSR&D Center for Clinical Management Research (CCMR), Ann Arbor, MI, and Univ. of Michigan) Ilgen MA (CCMR and Univ. of Michigan) Blow FC (CCMR and Univ. of Michigan) Ignacio RV (VA Serious Mental Illness Treatment Resource and Evaluation Center) Bohnert AS (CCMR and Univ. of Michigan)

Discontinuation from chronic opioid analgesics occurs for numerous reasons, including in many cases, due to concerns for opioid-related aberrant behaviors, and may be an indicator for risky opioid use or opioid use disorders (OUD) in these patients. In recent years, the VHA has implemented important measures, such as the Opioid Safety Initiative, to promote safer opioid-related prescribing. Although the OSI has been associated with reductions in high dosage opioid prescribing, little is known about the frequency of opioid discontinuation after OSI or how often Veterans who are discontinued go on to receive evidence based treatment for OUD.

This study examined the cohort of adult Veterans nationally who received opioid analgesic prescriptions chronically in a baseline period (1/2014-6/2014). We compared Veterans who were discontinued from opioid analgesics, defined as a > 90 day period without any opioid fills in the followup period (7/2014-12/2014), with those who were not discontinued, on receipt of pharmacotherapy for OUD (including buprenorphine, naltrexone and methadone) in addition to demographic and other clinical characteristics.

Among Veterans receiving opioids chronically at baseline, 6.3% (N = 8,758) were discontinued from opioids in the six-month followup period. 2.6% (N = 3,606) of Veterans prescribed opioids chronically received pharmacotherapy for OUD in the followup period, including 2.4% (N = 3,335) who received buprenorphine, 0.01% (N = 8) naltrexone, and 0.8% methadone (N = 1,168). There were no significant differences in receipt of pharmacotherapy for OUD in Veterans who were discontinued (2.3%, N = 205) compared to those who continued to receive opioid analgesics (2.6%, N = 3,401; p = 0.11). Veterans who were discontinued were also more likely to be younger, and more likely to be diagnosed with a serious mental illness, OUD, alcohol use disorder, and other drug-related substance use disorders.

Discontinuation from chronic opioids remains relatively rare, as was the use of OUD pharmacotherapy in this chronic opioid cohort. Veterans who were discontinued from opioids were no more likely to receive pharmacotherapy for OUD, which is concerning given their likely higher need for OUD treatment. Future studies should examine barriers to receipt of evidence-based treatment for OUD among Veterans discontinued from chronic opioids.

Additional efforts are likely needed to engage Veterans who are discontinued from chronic opioids and at risk for OUD in substance use disorder treatment.