Trends in Prevalent and Incident Opioid Receipt: an Observational Study in Veterans Health Administration 2004–2012

Abstract

BACKGROUND: Improved understanding of temporal and regional trends may support safe and effective prescribing of opioids. OBJECTIVE: We describe national, regional, and facilitylevel trends and variations in opioid receipt between fiscal years (FY) 2004 and 2012. DESIGN: Observational cohort study using Veterans Health Administration (VHA) administrative databases. PARTICIPANTS: All patients receiving primary care within 137 VHA healthcare systems during a given study year and receiving medications from VHA one year before and during a given study year. MAIN MEASURES: Prevalent and incident opioid receipt during each year of the study period. KEY RESULTS: The overall prevalence of opioid receipt increased from 18.9 % of all veteran outpatients in FY2004 to 33.4 % in FY2012, a 76.7 % relative increase. In FY2012, women had higher rates of prevalent opioid receipt than men (42.4 % vs. 32.9 %), and the youngest veterans (18-34 years) had higher prevalent opioid receipt compared to the oldest veterans (≥80 years) (47.6 % vs. 17.9 %). All regions in the United States saw increased rates of prevalent opioid receipt during this time period. Prevalence rates varied widely by facility: in FY2012, the lowest-prescribing facility had a rate of 13.5 %, and the highest of 50.8 %. Annual incident opioid receipt increased from 8.8 % in FY2004 to 10.2 % in FY2011, with a decline to 9.8 % in FY2012. Incident prescribing increased at some facilities and decreased at others. Facilities with high prevalent prescribing tended to have flat or decreasing incident prescribing rates during the study time frame. CONCLUSIONS: Rates of opioid receipt increased throughout the study time frame, with wide variation in prevalent and incident rates across geographical region, sex, and age groups. Prevalence and incidence rates reflect distinct prescribing practices. Areas with the highest prevalence tended to have lower increases in incident opioid receipt over the study period. This likely reflects facilitylevel variations in prescribing practices as well as baseline rates of prevalent use. Future work assessing opioid prescribing should employ methodologies to account for and interpret both prevalent and incident opioid receipt.

Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration

“…7 Trends of increasing opioid prescription use similarly have been identified in the private sector 22 and in Medicare recipients. 23 While opioid medications undeniably are essential to the short-term management of moderate to severe forms of acute pain, and perhaps for the control of select forms of severe, chronic pain (eg, cancer-related pain), the role of these medications in unexplained or functional GI disorders, and especially those without manifest structural disease, should remain quite limited.…”

“…5,6 Among patients served by the Veterans Health Administration (VHA), the annual prevalence of opioid prescribing is reported to have increased from 18.9% in fiscal year (FY) 2004 to 33.4% in FY2012 in less than a decade. 7 Expert guidelines recommend that chronic opioid therapy should be reserved for those suffering from intractable chronic pain not adequately managed with more conservative approaches (ie, cognitive and behavioural methods or rehabilitation) or interventional methods. [8][9][10] One group at special risk for expanding opioid use are patients with painful functional gastrointestinal disorders (FGIDs), unexplained GI symptoms with a predominant pain component such as irritable bowel syndrome (IBS) and functional dyspepsia (FD).…”

Traumatic injuries and persistent opioid use in the USA: findings from a nationally representative survey

“…In 2013, there were over 16 000 opioid-related deaths, a 200% increase relative to 2000 2. The increase in opioid-related deaths was concurrent with an increase in the number of users, the number of prescriptions filled and prescription costs 3. In 2002, over 27 million people purchased one or more outpatient-prescribed opioids, while this figure increased to over 36 million in 2012 4.…”

Capsule Commentary on Mosher et al., Trends in Prevalent and Incident Opioid Receipt: An Observational Study in Veterans Health Administration 2004–2012

“…1 Mosher and colleagues report that there has been an increase in the receipt of opiates since 2004 among Veterans, from 19 % in 2004 to 33 % in 2012. 2 They define receipt of opiates as "receipt of at least one opioid prescription during that year." This would include Veterans who had surgery and other procedures that require a short course of opiates during the outpatient post-procedure period, as well as Veterans who received opiates for acute injuries.…”