Declining Rates in VA Prescriptions for Long-Term Opioids
BACKGROUND:
Rapid and widespread escalation in long-term opioid prescribing over the past decades has led to numerous efforts to "turn the tide" on the opioid epidemic. VA has employed several strategies to combat the opioid epidemic, including deployment of educational initiatives, improving pain management programs, creating risk mitigation systems to enhance opioid safety, and expanding access to addiction treatment. This study sought to characterize the overall prevalence of opioid prescribing in the VA healthcare system from 2010 through 2016 by duration of use: short-term use (single opioid prescription or 2 prescriptions separated by >90 days), long-term use (>90 days of continuous opioid use within the calendar year), and intermediate-term use (any other pattern of opioid use). Using VA data, investigators identified all Veterans who received at least one outpatient prescription for opioids through the VA healthcare system during calendar years 2010 through 2016.
FINDINGS:
- Opioid prescribing trends followed similar trajectories in VA and non-VA settings, peaking around 2012 and subsequently declining. The prevalence of VA opioid prescribing was 20.8% in 2010 (n=962,193), 21.2% in 2012 (1,017,826), and declined annually to 16.1% in 2016 (n=803,888).
- Changes in long-term opioid prescribing accounted for 83% of the decline seen in VA patients. Comparing data from 2010-2011 to data from 2015-2016, declining rates in new long-term use accounted for more than 90% of the decreasing prevalence of long-term opioid use among Veterans, whereas increases in cessation among existing long-term users was less than 10%.
- Investigators observed a decrease in overall opioid prevalence between 2012 and 2015 of 16% in VA healthcare settings, compared to 13% reported in non-VA settings.
IMPLICATIONS:
- Recent VA opioid initiatives may be preventing patients from initiating long-term use, and these may offer valuable lessons generalizable to other healthcare systems.
LIMITATIONS:
- The primary limitation was the inability to observe opioid prescriptions filled by non-VA pharmacies.
- This analysis does not consider potential changes in rates of underlying pain diagnoses or other patient characteristics over time that might be associated with opioid prescribing.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D. All authors are part of HSR&D's Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City, IA.
Hadlandsmyth K, Mosher H, Vander Weg M, and Lund B. Decline in Prescription Opioids Attributable to Decreases in Long-Term Use: A Retrospective Study in Veterans Health Administration 2010-2016. Journal of General Internal Medicine. January 29, 2018; ePub ahead of print.
