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2023 HSR&D/QUERI National Conference Abstract

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4078 — Transition to Opioid Use Disorder Among Patients Prescribed Opioids in the Veterans Health Administration (VHA)

Lead/Presenter: Elizabeth Oliva,  COIN - Palo Alto
All Authors: Oliva EM (Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System), Hong J (Health Economics Resource Center, VA Palo Alto Health Care System) Boothroyd D (Quantitative Sciences Unit, Stanford University School of Medicine) Bounthavong M (Health Economics Resource Center, VA Palo Health Care System) Martins, SB (Geriatrics Research Education and Clinical Center, VA Palo Alto Health Care System) Humphreys K (Center for Innovation to Implementation, VA Palo Alto Health Care System) Wu J (Center for Innovation to Implementation, VA Palo Alto Health Care System) Bohnert ASB (Center for Clinical Management Research, Ann Arbor, MI) Garrido MM (Partnered Evidence-based Policy Resource Center, Boston VA Health Care System) Bustamante R (Center for Innovation to Implementation, VA Palo Alto Health Care System) Sandbrink F (Washington DC Veterans Affairs Medical Center; Department of Neurology, George Washington University)

Objectives:
While there is a great deal of concern about risk for opioid use disorder (OUD) among patients prescribed opioid analgesics, there are few large-scale studies of the transition to OUD among patients exposed to any prescription opioid analgesic. The few existing studies focus on individuals with chronic pain, multiple opioid prescriptions, and/or prescription OUD versus OUD generally. This study examined data from a larger VHA study of naloxone distribution among potential naloxone candidates (i.e., patients dispensed opioid analgesics and patients with OUD) to examine the transition to OUD among patients prescribed opioids between Fiscal Years (FY) 2014 to 2019.

Methods:
Six FY cohorts (FY2014-FY2019) of naloxone candidates were developed using data from VA’s Corporate Data Warehouse (i.e., patients dispensed opioid analgesics and/or with an OUD diagnosis). Dates of OUD diagnoses and prescription opioid analgesic dispensing were used to identify the date of first OUD diagnosis and first prescription opioid analgesic episode. Patients who had no OUD diagnosis before their first prescription opioid analgesic episode and the average time from initial opioid prescription to OUD diagnosis among new opioid starts were examined. A 2-year washout period from FY2012 to FY2013 was used to exclude patients prescribed opioids before the study began.

Results:
Between FY2014 to 2019, there were 2,699,577 patients dispensed an opioid analgesic who had no previous OUD diagnosis. Among these patients, 2.7% (n = 72,360) were diagnosed with an OUD at some point during the study period. Of the 72,360 patients diagnosed with an OUD, 19,009 were a new opioid start between FY2014 to FY2019. Among these new opioid starts that developed OUD, the mean transition to OUD occurred 635 days (SD = 528 days; median = 515 days) after the initial opioid analgesic prescription.

Implications:
While the transition from prescription opioid analgesics to OUD was relatively low (2.7%), given the large number of individuals prescribed opioid analgesics at any given time, the absolute number can be quite large. Given that mean transition to OUD occurred almost 2 years after the initial opioid analgesic prescription, studies that seek to examine this transition will need to include longer follow-up periods. Our findings are similar to a study using 2015 National Survey on Drug Use and Health (NSDUH) data which found that the 12-month prevalence of prescription opioid use disorders among adults using prescribed opioids was 2.1% (Han et al., 2017) and contrast with a Boscarino et al.’s (2015) study that found a 41.3% lifetime rate of prescription OUD among patients receiving five or more prescriptions for opioid therapy in past 12 months. Future analyses should examine transition rates among higher risk prescription opioid analgesic populations (e.g., high-dose, long-acting) and factors associated with transition (e.g., demographic; medical and mental health comorbidities).

Impacts:
Our study is one of the first to examine the transition to OUD among a large cohort of patients prescribed opioid analgesics between FY2014 to FY2019. Although transition to OUD was relatively low, there were still over 72,000 affected patients. Future studies seeking to examine the transition to OUD should include at least a 2-year follow-up period.