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RRP 13-251 – HSR&D Study

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RRP 13-251
Opioid prescribing in the VHA before and after the new Opioid Safety Initiative
Mark A. Ilgen PhD
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: September 2014 - August 2015

BACKGROUND/RATIONALE:
Prescription opioids are now one of the most commonly-prescribed groups of medications within the VHA and they play an important role in controlling pain for many Veterans. However, there are also concerns about the potential negative consequences of prescription opioids (.e.g., physiological dependence, misuse, unintentional injury due to sedation, impaired driving, overdose). The VHA designed the Opioid Safety Initiative to help decrease the use of opioid prescribing practices that might be associated with adverse outcomes.

OBJECTIVE(S):
The purpose of this project was to study changes in prescribing practices following the Opioid Safety Initiative.

METHODS:
VHA administrative health records were linked with data from Pharmacy Benefits Management (PBM) to generate monthly facility-level prescribing patterns of opioids and other medications. Interrupted time series analyses determined the extent of change in prescribing practices before and after the implementation of the OSI.

FINDINGS/RESULTS:
Overall, there was a downward trend in prescribing of high dose opioids from Oct 2012 to Sept 2014. Initially in Oct 2012, 9.75% of patient receiving opioids were prescribed opioids at doses > 100 morphine equivalents (MEQ), which decreased to 9.09% in Sept 2014. And initially 3.49% of patient were prescribed doses > 200MEQ, which decreased to 2.94% over the same period. The implementation of OSI in October 2013 was associated with a small but significant decrease in the trend of high dose opioid prescriptions (both > 100meq and >200meq). There was also a downward trend in concurrent prescribing of benzodiazepines with opioids. In Oct. 2012, 23.41% of patients receiving opioids also received a benzodiazepine, and this decreased to 20.86% by Sept 2014. However, OSI was actually associated with a significant increase (compared to pre-OSI) in the trend of concurrent benzodiazepine prescriptions. There was wide variability in change in prescribing over time across facilities.

IMPACT:
Our findings indicate that, overall, the implementation of OSI was associated with a small but significant decrease in trend of high dose opioid prescriptions across VHA, but not in concurrent benzodiazepine prescriptions. There is substantial variability across facilities in the extent of change in prescribing that followed OSI implementation. We cannot rule out that other factors, such as greater national recognition of the risks of opioids, may have contributed to the decreasing trend in prescribing high dose opioids in the VHA. In addition, we have not assessed the impact of the variability in implementation of OSI across facilities. Regardless, these findings provide key data about the potential utility of VHA policies that target prescribing practices, such as the OSI, and also highlight the extent to which many facilities exhibited very limited change that followed the OSI. These findings could help inform future efforts to further influence opioid prescribing practices in the VHA.

PUBLICATIONS:

Journal Articles

  1. Lin LA, Bohnert ASB, Kerns RD, Clay MA, Ganoczy D, Ilgen MA. Impact of the Opioid Safety Initiative on opioid-related prescribing in veterans. Pain. 2017 May 1; 158(5):833-839.
Conference Presentations

  1. Chee CP. Hospital Input and Output Decisions: Evidence from the Medicare Program. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 8; San Diego, CA.


DRA: Substance Abuse and Addiction
DRE: Prevention
Keywords: QUERI Implementation
MeSH Terms: none