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. 2020 Dec 1:217:108248.
doi: 10.1016/j.drugalcdep.2020.108248. Epub 2020 Aug 27.

The Association between Opioid Discontinuation and Heroin Use: A Nested Case-Control Study

Ingrid A Binswanger  1 , Jason M Glanz  2 , Mark Faul  3 , Jo Ann Shoup  4 , LeeAnn M Quintana  4 , Jennifer Lyden  5 , Stan Xu  6 , Komal J Narwaney  4
Affiliations

The Association between Opioid Discontinuation and Heroin Use: A Nested Case-Control Study

Ingrid A Binswanger et al. Drug Alcohol Depend. .

Abstract

Background: Opioid prescribing guidelines recommend reducing or discontinuing opioids for chronic pain if harms of opioid treatment outweigh benefits. As opioid discontinuation becomes more prevalent, it is important to understand whether opioid discontinuation is associated with heroin use. In this study, we sought to assess the association between opioid discontinuation and heroin use documented in the medical record.

Methods: A matched nested case-control study was conducted in an integrated health plan and delivery system in Colorado. Patients receiving opioid therapy in the study period (January 2006-June 2018) were included. Opioid discontinuation was defined as ≥45 days with no opioids dispensed after initiating opioid therapy. The heroin use onset date represented the index date. Case patients were matched to up to 20 randomly selected patients without heroin use (control patients) by age, sex, calendar time, and time between initiating opioid therapy and the index date. Conditional logistic regression models estimated matched odds ratios (mOR) for the association between an opioid discontinuation prior to the index date and heroin use.

Results: Among 22,962 patients prescribed opioid therapy, 125 patients (0.54%) used heroin after initiating opioid therapy, of which 74 met criteria for inclusion in the analysis. The odds of opioid discontinuation were approximately two times higher in case patients (n = 74) than control patients (n = 1045; mOR = 2.19; 95% CI 1.27-3.78).

Conclusions: Among patients prescribed chronic opioid therapy, the observed increased risk for heroin use associated with opioid discontinuation should be balanced with potential benefits.

Keywords: Opioid discontinuation; heroin use; prescription opioid use.

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Conflict of interest statement

Declarations of interest

None

Figures

Fig. 1.
Fig. 1.
Sample eligible case patients and control patients prescribed opioid therapy.
Fig. 2.
Fig. 2.
Identification of case and control patients in an opioid therapy cohort (N = 22,962). Abbreviations: ICD-9/10: International Classification of Diseases, Ninth Revision/Tenth Revision a14 patients had both a heroin ICD 9/10 code positive for heroin overdose and were identified using the electronic text string search algorithm bHeroin use occurred less than 6 months prior to the start of opioid therapy
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