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Observational Study
. 2018 Jun;33(6):818-824.
doi: 10.1007/s11606-017-4283-8. Epub 2018 Jan 29.

Decline in Prescription Opioids Attributable to Decreases in Long-Term Use: A Retrospective Study in the Veterans Health Administration 2010-2016

Katherine Hadlandsmyth  1   2 , Hilary Mosher  1   3 , Mark W Vander Weg  1   3 , Brian C Lund  4
Affiliations
Observational Study

Decline in Prescription Opioids Attributable to Decreases in Long-Term Use: A Retrospective Study in the Veterans Health Administration 2010-2016

Katherine Hadlandsmyth et al. J Gen Intern Med. 2018 Jun.

Abstract

Background: Improved understanding of temporal trends in short- and long-term opioid prescribing may inform efforts to curb the opioid epidemic.

Objective: To characterize the prevalence of short- and long-term opioid prescribing in the Veterans Health Administration (VHA) from 2010 to 2016.

Design: Observational cohort study using VHA databases.

Participants: All patients receiving at least one outpatient prescription through the VHA during calendar years 2010 through 2016.

Main measures: Prevalence of opioid use from 2010 through 2016, stratified by short-term, intermediate-term, and long-term use. Temporal trends in discontinuation among existing long-term users and initiation of new long-term use and the net impact on rates of long-term opioid use. Relative likelihood of transitioning to long-term opioid use contrasted with use patterns in the prior year.

Key results: The prevalence of opioid prescribing was 20.8% in 2010, peaked at 21.2% in 2012, and declined annually to 16.1% in 2016. Between 2010 and 2016, reductions in long-term opioid prescribing accounted for 83% of the overall decline in opioid prescription fills. 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 in the VHA, whereas increases in cessation among existing long-term users accounted for less than 10%. The relative risk of transitioning to long-term use during 2016 was 6.5 (95% CI: 6.4, 6.7) among short-term users and 35.5 (95% CI: 34.8, 36.3) among intermediate users, relative to patients with no opioid prescriptions filled during 2015.

Conclusions: Opioid prescribing trends followed similar trajectories in VHA and non-VHA settings, peaking around 2012 and subsequently declining. However, changes in long-term opioid prescribing accounted for most of the decline in the VHA. Recent VA opioid initiatives may be preventing patients from initiating long-term use. This may offer valuable lessons generalizable to other healthcare systems.

Keywords: opioid; prevalence; veteran.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
The changing prevalence of opioid prescribing in the VA healthcare system.
Figure 2
Figure 2
Shift toward decreasing chronic opioid use of as a function of the input of new chronic use and output of cessation of chronic use.
See this image and copyright information in PMC

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