Opioid Prescribing Safety Initiative Effective in Decreasing Rates of Opioid Prescribing for Older Veterans with Osteoarthritis
Few investigations have examined patterns of opioid and non-opioid analgesic prescribing and concurrent pain intensity ratings before and after the institution of safer prescribing programs, such as VA's system-wide Opioid Safety Initiative (OSI) in October 2013. The EAASE project is an ongoing multicenter observational study evaluating the safety and effectiveness of analgesic medications prescribed to older individuals diagnosed with osteoarthritis. Using data from this study, investigators examined national trends in opioid and non-opioid analgesic prescribing before and after implementation of VA's OSI initiative. Monthly rates of musculoskeletal analgesic prescriptions for VA outpatients – older than age 50 who had osteoarthritis of the knee and/or hip – were calculated for a five-year period (January 1, 2012 to December 31, 2016). During the study period, there were 8,384,563 analgesic prescriptions written for 348,787 VA outpatients. Pain intensity ratings also were summarized as the percent of Veterans reporting mild, moderate, and severe pain. In addition, investigators assessed patient sociodemographics.
- Before the implementation of the Opioid Safety Initiative, total analgesic prescriptions showed a steady rise, which abruptly decreased to a flat trajectory after the OSI was implemented. This trend was primarily due to a decrease in opioid prescribing after OSI, as well as a significant modest rise in acetaminophen prescriptions post-OSI.
- Among Veterans reporting pain, the intensity of pain remained unchanged over the study period. Thus, changes in analgesic prescribing trends were not accompanied by changes in reported pain intensity for older Veterans with osteoarthritis.
- No changes in non-steroidal anti-inflammatory drug prescribing were observed.
- Over the period 2012-2016, VA's successful efforts to reduce opioid prescribing did not result in worsening pain among patients with osteoarthritis. As the drop in opioid prescribing has continued, future studies should continue to investigate changing rates of opioid and non-opioid analgesic medications – and the impact these have on patient safety and pain intensity.
- Data and results do not reflect causality because this was an observational study.
- Although the emphasis was on evaluation of prescribing trends before and after the OSI implementation, concurrent national policies related to analgesic prescribing, as well as public awareness of risks, also may have impacted changes in prescribing trends.
This study was funded by HSR&D (IIR 12-106). Drs. Trentalange, Runels, Bean, Brody, and Hwang are part of the James J. Peters VAMC. Drs. Kerns and Brandt are part of HSR&D's Pain Research, Informatics, Multimorbidities and Education (PRIME) Center.
Trentalange M, Runels T, Bean A, Kerns R, Bair M, Brody A, Brandt C, Hwang U, and the Evaluating Arthritis Analgesic Safety and Effectiveness (EAASE) investigators. Analgesic Prescribing Trends in a National Sample of Older Veterans with Osteoarthritis: 2012-2017. Pain. June 2019;160(6):1319-26