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Multicenter Study
. 2019 May;17(6):1165-1174.e3.
doi: 10.1016/j.cgh.2018.10.021. Epub 2018 Oct 17.

Characteristics of Opioid Prescriptions to Veterans With Cirrhosis

Shari S Rogal  1 , Lauren A Beste  2 , Ada Youk  3 , Michael J Fine  4 , Bryan Ketterer  5 , Hongwei Zhang  5 , Steven Leipertz  6 , Maggie Chartier  7 , Chester B Good  8 , Kevin L Kraemer  4 , Matthew Chinman  9 , Timothy Morgan  10 , Walid F Gellad  4
Affiliations
Multicenter Study

Characteristics of Opioid Prescriptions to Veterans With Cirrhosis

Shari S Rogal et al. Clin Gastroenterol Hepatol. 2019 May.

Abstract

Background & aims: Despite increased risks for adverse effects in patients with cirrhosis, little is known about opioid prescriptions for this population. We aimed to assess time trends in opioid prescribing and factors associated with receiving opioids among patients with cirrhosis.

Methods: Among Veterans with cirrhosis, identified using national Veterans Health Administration data (2005-2014), we assessed characteristics of patients and their prescriptions for opioids. We calculated the annual proportion of patients receiving any opioid prescription. Among opioid recipients, we assessed prescriptions that were long-term (>90 days' supply), for high doses (>100 MME/day), or involved combinations of opioids and acetaminophen or benzodiazepine. We evaluated patient characteristics independently associated with long-term and any opioid prescriptions using mixed-effects regression models.

Results: Among 127,239 Veterans with cirrhosis, 97,974 (77.0%) received a prescription for an opioid. Annual opioid prescriptions increased from 36% in 2005 to 47% in 2014 (P < .01). Among recipients of opioids, the proportions of those receiving long-term prescriptions increased from 47% in 2005 to 54% in 2014 (P < .01), and19%-21% received prescriptions for high-dose opioids. Prescriptions for combinations of opioids and acetaminophen decreased from 68% in 2005 to 50% in 2014 (P < .01) and for combinations of opioids and benzodiazepines decreased from 24% to 19% over this time (P < .01). Greater probability of long-term opioid prescriptions was independently associated with younger age, female sex, white race, hepatitis C, prior hepatic decompensation, hepatocellular carcinoma, mental health disorders, nicotine use disorders, medical comorbidities, surgery, and pain-related conditions.

Conclusion: Among Veterans with cirrhosis, 36%-47% were prescribed opioids in each year. Mental health disorders and hepatic decompensation were independently associated with long-term opioid prescriptions.

Keywords: Addiction; Analgesia; Chronic; Medication Safety; Narcotic.

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Figures

Figure 1.
Figure 1.. Observed and adjusted annual percent of Veterans with cirrhosis prescribed opioids and long-term opioids, 2005–2014
The increase in annual opioid prescribing to Veterans with cirrhosis over the study period was statistically significant (p<0.001) both before (solid line) and after (dotted line) adjusting for comorbitities and patient- and liver-related characteristics.
Figure 2.
Figure 2.
Proportion of patients prescribed common types of opioid medications alone and in combination with acetaminophen, 2005–2014
See this image and copyright information in PMC

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