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2019 HSR&D/QUERI National Conference Abstract

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4020 — Pain care utilization following episodes of specialty substance use disorder treatment

Lead/Presenter: Travis Lovejoy,  COIN - Portland
All Authors: Lovejoy TI (Center to Improve Veteran Involvement in Care, VA Portland Health Care System), Morasco BJ (Center to Improve Veteran Involvement in Care, VA Portland Health Care System), Wyse J (Center to Improve Veteran Involvement in Care, VA Portland Health Care System) Holloway J (Center to Improve Veteran Involvement in Care, VA Portland Health Care System) Dobscha SK (Center to Improve Veteran Involvement in Care, VA Portland Health Care System)

Objectives:
Substance use disorders (SUDs) are common in patients with chronic non-cancer pain and associated with poor pain treatment engagement and increased risk of opioid-related adverse events, including overdose and death. Unfortunately, patients with active SUDs are often difficult to engage in care, and untreated or undertreated pain may perpetuate substance use. Specialty SUD treatment programs may be optimally positioned to concomitantly treat active SUDs and help patients engage in needed pharmacologic and non-pharmacologic pain care.

Methods:
We utilized retrospective VA administrative data to identify a cohort of all U.S. Department of Veterans Affairs (VA) patients with chronic non-cancer pain and comorbid SUD diagnoses between 2010 and 2013. A total of 126,390 patients met study inclusion criteria; 18,964 of these patients subsequently received a full episode of SUD treatment, while an additional 63,939 received some specialty SUD treatment without completing a full treatment episode. Generalized estimating equations controlled for key demographic and clinical variables and compared 12-month pain care utilization between patients with some or full specialty SUD treatment engagement to those with no specialty SUD treatment.

Results:
Relative to patients who received no specialty SUD treatment, those who received incomplete episodes of SUD treatment were more likely to be prescribed Non-opioid Pharmacotherapy (OR = 1.05 [95% CI = 1.02-1.08]) and engage in Occupational Therapy (OR = 1.47[1.40-1.53]), while less likely to be prescribed Opioid Pharmacotherapy (OR = 0.92[0.90-0.94]) and have Specialty Pain Clinic (OR = 0.92[0.88-0.96]) or Primary Care encounters (OR = 0.98[0.97-0.99]). Patients who completed full episodes of SUD treatment, compared to patients who received no SUD treatment, were more likely to be prescribed Non-opioid Pharmacotherapy (OR = 1.72[1.66-1.79]) and engage in Rehabilitation Medicine (OR = 1.75[1.63-1.89]), Occupational Therapy (OR = 5.60[5.28-5.94]), Specialty Pain Clinic (OR = 1.20[1.11-1.30]), and Primary Care encounters (OR = 1.57[1.53-1.60]), while less likely to be prescribed Opioid Pharmacotherapy (OR = 0.82[0.79-0.85]).

Implications:
For patients with comorbid chronic non-cancer pain and active SUDs, episodes of specialty SUD treatment may present an opportunity to deliver needed pain care to this hard-to-engage population.

Impacts:
Adequately treating pain in Veterans with comorbid SUDs may reduce overall opioid-related morbidity and mortality among a high-risk Veteran population.