Impact of complementary health approaches on opioid prescriptions among veterans with musculoskeletal disorders - A retrospective cohort study

Abstract

To examine whether complementary and integrative health approaches mitigate opioid prescriptions for pain and whether the relationship differs by post-dramatic stress disorder (PTSD) diagnosis, we followed 1,993,455 Veterans with musculoskeletal disorders during 2005-2017 using Veterans Healthcare Administration electronic health records. Complementary and integrative health (CIH) approaches were defined as ≥ 1 primary care visits for meditation, Yoga, and acupuncture etc using natural language processing. Opioid prescriptions were ascertained from pharmacy dispensing records. A propensity score was estimated and used to match one control Veteran to each CIH recipient. Over the 2-year follow-up period after the index diagnosis, 140,902 (7.1 %) Veterans received ≥ 1 modalities. Among the matched analytic sample (272,296 Veterans), the likelihood of dispensing opioid prescriptions was significantly lower for Veterans in the CIH group than their controls [adjusted hazard ratio (aHR), 0.45 (95 % Confidence Intervals (CI): 0.44-0.46)]. The association did not differ between Veterans with [aHR: 0.46 (95 % CI: 0.45-0.47)] and without [aHR: 0.44 (95 % CI: 0.43-0.45)] PTSD. In sensitivity analyses, the exposure group had 3.82 (95 % CI: 3.76-3.87) months longer restricted mean survival time to opioid initiation, 2 % (95 % CI: 4 %-1 %) lower morphine equivalent and 17 % lower total days' supply (95 % CI: 18 %-16 %). The relationship remains significant but was attenuated after eliminating waiting time for the exposure group (aHR, 0.63 (95 % CI: 0.62-0.64)). These observations suggest that CIH approaches may help reduce opioid prescriptions for Veterans with musculoskeletal disorders and related pain. The impact of the timing of receiving such approaches warrants further investigation. PERSPECTIVE: This article presents a quasi-experimental investigation into potential benefit of complementary and integrative health approaches (CIH) on de-prescribing opioids. The findings may potentially help clinicians who are seeking non-pharmacological alternative options to manage patient pain and opioid dependence".

Keywords: Complementary and integrative health (CIH); Musculoskeletal disorders (MSD); Opioids prescriptions; Post traumatic stress disorder (PTSD); Propensity score (PS).