Home > Impact of opioid dose reduction and risk mitigation initiatives on chronic opioid therapy patients at higher risk for opioid-related adverse outcomes.

Thakral, Manu and Walker, Rod L and Saunders, Kathleen and Shortreed, Susan M and Dublin, Sascha and Parchman, Michael and Hansen, Ryan N and Ludman, Evette and Sherman, Karen J and Von Korff, Michael . (2018) Impact of opioid dose reduction and risk mitigation initiatives on chronic opioid therapy patients at higher risk for opioid-related adverse outcomes. Pain Medicine, 19 (12) https://doi.org/10.1093/pm/pnx293

URL: https://academic.oup.com/painmedicine/article-look...

Objective: We aimed to determine if opioid risk reduction initiatives including dose reduction and risk mitigation strategies for chronic noncancer pain patients receiving chronic opioid therapy (COT) had a differential impact on average daily opioid doses of COT patients at higher risk for opioid-related adverse outcomes compared with lower-risk patients.

Design: Interrupted time series.
Setting: Group Health Cooperative (GH), a health care delivery system and insurance within Washington State, between 2006 and 2014.

Population: GH enrollees on COT defined as receiving a supply of 70 or more days of opioids within 90 days using electronic pharmacy data for filled prescriptions.

Methods: We compared the average daily morphine equivalent doses (MED) of COT patients with and without each of the following higher-risk characteristics: mental disorders, substance use disorders, sedative use, and male gender.

Results: In all four pairwise comparisons, the higher-risk subgroup had a higher average daily MED than the lower-risk subgroup across the study period. Adjusted for covariates, modest differences in the annual rate of reduction in average daily MED were noted between higher- and lower-risk subgroups in three pairwise comparisons: those with mental disorders vs without (-8.2 mg/y vs -5.2 mg/y, P = 0.005), with sedative use vs without (-9.2 mg/y vs -5.8 mg/y, P = 0.004); mg), in men vs women (-8.8 mg/y vs -5.9 mg/y, P = 0.01).

Conclusion: Using clinical policy initiatives in a health care system, dose reductions were achieved among COT patients at higher risk for opioid-related adverse outcomes that were at least as large as those among lower-risk patients.


Item Type:Evidence resource
Drug Type:Opioid
Intervention Type:AOD disorder harm reduction
Date:1 December 2018
Page Range:pp. 2450-2458
Volume:19
Number:12
EndNote:View
Subjects:B Substances > Opioids (opiates)
J Health care, prevention and rehabilitation > Patient care management

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