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

Hadlandsmyth, Katherine; Mosher, Hilary J.; Weg, Mark W. Vander; Lund, Brian C.

doi:10.1007/s11606-017-4283-8

Cited by 60 publications

(59 citation statements)

References 12 publications

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“…Unfortunately, the TEDS does not include whether the veteran is also enrolled in VHA. The trend for both urban and rural veterans reflects an increase in admissions for opioid use in the community, which is in contrast to Hadlandsmyth and associates’ study using VHA administrative data that demonstrated a decline in long‐term use of prescription opioids in VHA‐enrolled veterans. These 2 disparate results warrant further investigation to determine what occurs for veterans who seek but do not receive opiates within VHA.…”

Section: Limitationscontrasting

confidence: 75%

“…In turn, opioid pain management is a significant risk factor for later opioid and heroin misuse in both veteran and civilian populations . Since 2012, both the Department of Defense and VHA have initiated prescription guidelines to limit long‐term medication pain management, and there is initial evidence based on analysis of VHA administrative data that these measures are reducing long‐term opiate prescription use in VHA . However, opioid misuse among veterans and the rates of substance use disorders (SUDs) remain high, suggesting the need for other measures to address this problem …”

Section: Purposementioning

confidence: 99%

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Community Treatment for Opioid Use Disorders in Urban and Rural Veterans

Turvey

Lund

Jones

et al. 2019

The Journal of Rural Health

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Purpose The recent opioid crisis is characterized by a relatively greater increase in opioid use disorder and related mortality in rural populations when compared with urban populations.1‐5 As almost a quarter of our nation's veterans reside in rural settings, the United States Veterans Health Administration (VHA) is interested in the impact of this epidemic on rural veterans. This study aims to develop a comprehensive understanding of the trends in substance use disorders (SUD) in veterans seeking treatment from community, non‐VHA providers. Methods Using Substance Abuse and Mental Health Services Administration (SAMHSA)’s Treatment Episode Data Set (TEDS), this study presents the prevalence of treatment for veterans seeking initial admission into publicly funded non‐VHA SUD treatment centers for years 2011‐2016. Comparisons were made for all SUD types. Multivariate trend analysis based on annual data from 2011 to 2016 compared urban and rural veterans for opioid use disorder treatment. Findings Both urban and rural veterans had comparable rates of treatment for SUD, though rural veterans had slightly higher rates of injectable (11.2% vs 8.7%; P < .001) and opiate drug use disorder admissions (20.7% vs 18.1%; P = .014). Both urban and rural showed an increase in admissions for opioid, heroin, and injectable drug use disorders between 2011 and 2016 (P < .001). Conclusions Comprehensive understanding of veteran SUD and treatment should include national‐level data on community non‐VHA treatment. SAMHSA's TEDS for years 2011‐2016 provides clinical information for more than 90,000 veterans and indicates continued increase in treatment seeking for opioid use disorders, particularly for rural veterans.

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Section: Limitationscontrasting

confidence: 75%

Section: Purposementioning

confidence: 99%

Community Treatment for Opioid Use Disorders in Urban and Rural Veterans

Turvey

Lund

Jones

et al. 2019

The Journal of Rural Health

Self Cite

View full text Add to dashboard Cite

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“…Consistent with national trends, Hadlandsmyth et al 6 found that the prevalence of overall opioid prescribing declined between 2010 and 2016, from 21 to 16%. Short-term prescribing fell only 1.6%, but long-and intermediate-term prescribing fell 25 and 32%, respectively.…”

mentioning

confidence: 73%

“…According to recent systematic reviews, many studies examining interventions for dose reduction or discontinuation of long-term opioid use are of poor quality with uncontrolled designs. 2 Hadlandsmyth et al 6 and other studies have shown promising developments in fighting the opioid crisis. Nonetheless, there is more work to do.…”

mentioning

confidence: 99%

“…This is where the VHA's experience offers considerable hope. Based on a cohort of patients with any prescriptions (about five million patients per year), the study by Hadlandsmyth et al 6 shows that the VHA's reduction in opioid prescribing has been led by lower rates of long-term opioid use. The investigators classified the duration of opioid use into four categories: no use, short-term use (single opioid prescription or two prescriptions separated by > 90 days), long-term use (> 90 days), and intermediate-term use (anything else).…”

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confidence: 99%

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Reducing Long-term Opioid Use in the Veterans Health Administration

Minegishi

Frakt

2018

J GEN INTERN MED

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Assessment of Opioid Prescribing Patterns in a Large Network of US Community Health Centers, 2009 to 2018

et al. 2020

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IMPORTANCE Understanding opioid prescribing patterns in community health centers (CHCs) that disproportionately serve low-income patients may help to guide strategies to reduce opioidrelated harms. OBJECTIVE To assess opioid prescribing patterns between January 1, 2009, and December 31, 2018, in a network of safety-net clinics serving high-risk patients. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of 3 227 459 opioid prescriptions abstracted from the electronic health records of 2 129 097 unique primary care patients treated from 2009 through 2018 at a network of CHCs that included 449 clinic sites in 17 states. All age groups were included in the analysis. MAIN OUTCOMES AND MEASURES The following measures were described at the population level for each study year: (1) percentage of patients with at least 1 prescription for an opioid by age and sex, (2) number of opioid prescriptions per 100 patients, (3) number of long-acting opioid prescriptions per 100 patients, (4) mean annual morphine milligram equivalents (MMEs) per patient, (5) mean MME per prescription, (6) number of chronic opioid users, and (7) mean of high-dose opioid users. RESULTS The study population included 2 129 097 patients (1 158 413 women [54.4%]) with a mean (SD) age of 32.2 (21.1) years and a total of 3 227 459 opioid prescriptions. The percentage of patients receiving at least 1 opioid prescription in a calendar year declined 67.4% from 15.9% in 2009 to 5.2% in 2018. Over the 10-year study period, a greater percentage of women received a prescription (13.1%) compared with men (10.9%), and a greater percentage of non-Hispanic White patients (18.1%) received an opioid prescription compared with non-Hispanic Black patients (9.5%), non-Hispanic patients who self-identified as other races (8.0%), and Hispanic patients (6.9%). The number of opioid prescriptions for every 100 patients decreased 73.7% from 110.8 in 2009 to 29.1 in 2018. The number of long-acting opioids for every 100 patients decreased 85.5% during the same period, from 22.0 to 3.2. The MMEs per patient decreased from 1682.7 in 2009 to 243.1 in 2018, a decline of 85.6%. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the opioid prescribing rate in 2009 in the CHC network was higher than national population estimates but began to decline earlier and more precipitously. This finding likely reflects harm mitigation policies and efforts at federal, state, and clinic levels and strong clinical quality improvement strategies within the CHCs.

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

Cited by 60 publications

References 12 publications

Community Treatment for Opioid Use Disorders in Urban and Rural Veterans

Community Treatment for Opioid Use Disorders in Urban and Rural Veterans

Reducing Long-term Opioid Use in the Veterans Health Administration

Assessment of Opioid Prescribing Patterns in a Large Network of US Community Health Centers, 2009 to 2018

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