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2019 HSR&D/QUERI National Conference Abstract

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4055 — Opioid Prescribing Following Opioid-Related Inpatient Hospitalizations by Diagnosis

Lead/Presenter: Pooja Lagisetty,  COIN - Ann Arbor
All Authors: Lagisetty PA PA (Center for Clinical Management and Research, Ann Arbor VA ), Lin LA (Center for Clinical Management and Research, Ann Arbor VA), Ganoczy D (Center for Clinical Management and Research, Ann Arbor VA) Haffajee RL (University of Michigan School of Public Health) Iwashyna TJ (Center for Clinical Management and Research, Ann Arbor VA) Bohnert A (Center for Clinical Management and Research, Ann Arbor VA)

Objectives:
The majority of opioid-related hospitalizations are not related to overdose, but instead labeled as visits for opioid dependence and abuse. However, there is little known about patient characteristics and opioid prescribing trajectories for these non-overdose visits. To examine opioid-prescribing patterns before and after opioid-related hospitalizations for all opioid-related indications, not limited to overdose.

Methods:
We conducted a retrospective cohort analysis of Veterans Health Administration (VHA) administrative claims from 2011-2014 including all VHA patients who were hospitalized between fiscal years 2011-2014 and had at least one prescription opioid medication filled through the VHA pharmacy prior to their hospitalization. We examined opioid dispensing trajectories before and after hospitalization by opioid-related indication (i.e., opioid dependence and/or abuse versus overdose) compared to prescribing patterns for non-opioid-related hospitalizations.

Results:
In a cohort of VHA pharmacy users with prior opioid prescriptions, 9,057 unique patients had opioid-related hospitalizations: 6571 were for opioid dependence/abuse, 2,486 for overdose, and 484,648 patients had a non-opioid-related hospitalizations. Overall, opioid dosage dropped significantly (36% for dependence/abuse, 22% for overdose, and 2% for non-opioid diagnoses, p < 0.001) across all three categories when comparing dose 57-63 days following admission to 57-63 days prior to hospitalization. However, nearly 63% of patients remained on the same dose or increased their opioid dose at 60 days following an opioid-related hospitalization. Patients with admissions for opioid dependence and/or abuse had a statistically significant higher prevalence of all mental health diagnoses (e.g., depression, serious mental illness, post-traumatic stress disorder, and anxiety and substance use disorders) compared to those with and opioid overdose or non-opioid-related admissions.

Implications:
Hospitalizations for opioid dependence/abuse are far more common than hospitalizations for overdose within the VHA and tend to be in patients with more severe mental health comorbidity. Opioid prescribing after discharge remains high for both overdose and dependence/abuse cohorts.

Impacts:
Nationally there has been increased focus on overdose prevention and safe transitions for patients being treated in acute settings following overdose. However, our findings suggest that Veterans with hospitalizations for dependence/abuse may actually have more severe mental health comorbidities warranting similarly intensive transitions programs. Future VA interventions may need to be tailored to these two very different patient populations.