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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 5/2015

01-05-2015 | Original Research

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

Authors: H. J. Mosher, MFA, M.D., E. E. Krebs, M.D., M.P.H., M. Carrel, Ph.D., P. J. Kaboli, M.D., M.S., M. W. Vander Weg, Ph.D., B.C. Lund, Pharm.D.

Published in: Journal of General Internal Medicine | Issue 5/2015

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ABSTRACT

Background

Improved understanding of temporal and regional trends may support safe and effective prescribing of opioids.

Objective

We describe national, regional, and facility-level 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 facility-level 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.
Literature
1.
Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-Assisted Therapies—Tackling the Opioid-Overdose Epidemic. N Engl J Med. 2014:online first April 23, 2014.
2.
Alexander GC, Kruszewski SP, Webster DW. Rethinking opioid prescribing to protect patient safety and public health. JAMA. 2012;308(18):1865–6.CrossRefPubMed
3.
Bohnert AS, Ilgen MA, Trafton JA, et al. Trends and Regional Variation in Opioid Overdose Mortality Among Veterans Health Administration Patients, Fiscal Year 2001 to 2009. Clin J Pain. Nov 25 2013.
4.
Warner MLC, Makuc DM, Anderson RN, Minino AM. Drug poisoning deaths in the United States, 1980–2008. Hyattsville, MD: US Department of Health and Human Service, CDC, National center for Health Statistics; 2011.
5.
Carey B. Prescription painkillers seen as a gateway to heroin. The New York Times. February 10, 2014, 2014.
6.
Catan T, Perez E. A pain-drug champion has second thoughts. The Wall Street Journal. December 17, 2012, 2012.
7.
8.
Daubresse M, Chang HY, Yu Y, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000–2010. Med Care. 2013;51(10):870–8.CrossRefPubMed
9.
Olsen Y, Daumit GL, Ford DE. Opioid prescriptions by U.S. primary care physicians from 1992 to 2001. J Pain. 2006;7(4):225–35.CrossRefPubMed
10.
Olfson M, Wang S, Iza M, Crystal S, Blanco C. National trends in the office-based prescription of schedule II opioids. J Clin Psychiatry. 2013;74(9):932–9.CrossRefPubMed
11.
Paulozzi LJ, Ryan GW. Opioid analgesics and rates of fatal drug poisoning in the United States. Am J Prev Med. 2006;31(6):506–11.CrossRefPubMed
12.
Sullivan MD, Edlund MJ, Fan MY, Devries A, Brennan Braden J, Martin BC. Trends in use of opioids for non-cancer pain conditions 2000–2005 in commercial and Medicaid insurance plans: the TROUP study. Pain. 2008;138(2):440–9.CrossRefPubMedCentralPubMed
13.
Gellad WF, Good CB, Amuan ME, Marcum ZA, Hanlon JT, Pugh MJ. Facility-level variation in potentially inappropriate prescribing for older veterans. J Am Geriatr Soc. 2012;60(7):1222–9.CrossRefPubMedCentralPubMed
14.
Franklin GM. Opioids for chronic noncancer pain: A position paper of the American Academy of Neurology. Neurology. 2014;83(14):1277–84.CrossRefPubMed
15.
16.
Ernst ME, Lund BC. Renewed interest in chlorthalidone: evidence from the Veterans Health Administration. J Clin Hypertens. 2010;12(12):927–34.CrossRef
17.
Lund BC, Charlton ME, Steinman MA, Kaboli PJ. Regional differences in prescribing quality among elder veterans and the impact of rural residence. J Rural Health Off J Am Rural Health Assoc Natl Rural Health Care Assoc. 2013;29(2):172–9.CrossRef
18.
19.
Giraudon I, Lowitz K, Dargan PI, Wood DM, Dart RC. Prescription Opioid Abuse in the United Kingdom. Br J Clin Pharmacol. Apr 18 2013.
20.
Bernardy NC, Lund BC, Alexander B, Friedman MJ. Increased polysedative use in veterans with posttraumatic stress disorder. Pain Med. 2014;15(7):1083–90.CrossRefPubMed
21.
22.
Edlund MJ, Austen MA, Sullivan MD, et al. Patterns of Opioid Use for Chronic Non-Cancer Pain in the Veterans Health Administration from 2009 to 2011. Pain. Aug 29 2014.
23.
Morden NE, Munson JC, Colla CH, et al. Prescription opioid use among disabled medicare beneficiaries: intensity, trends, and regional variation. Med Care. 2014;52(9):852–9.CrossRefPubMed
24.
Von Korff M, Saunders K, Thomas Ray G, et al. De facto long-term opioid therapy for noncancer pain. Clin J Pain. 2008;24(6):521–7.CrossRefPubMed
25.
Campbell CI, Weisner C, Leresche L, et al. Age and gender trends in long-term opioid analgesic use for noncancer pain. Am J Public Health. 2010;100(12):2541–7.CrossRefPubMedCentralPubMed
26.
27.
Sinnott P, Wagner TH. Low back pain in VA users. Arch Intern Med. 2009;169(14):1338–9. author reply 1339.CrossRefPubMed
28.
Oliva EM, Midboe AM, Lewis ET, et al. Sex Differences in Chronic Pain Management Practices for Patients Receiving Opioids from the Veterans Health Administration. Pain Med. Jul 13 2014.
29.
Lew HL, Otis JD, Tun C, Kerns RD, Clark ME, Cifu DX. Prevalence of chronic pain, posttraumatic stress disorder, and persistent postconcussive symptoms in OIF/OEF veterans: polytrauma clinical triad. J Rehabil Res Dev. 2009;46(6):697–702.CrossRefPubMed
30.
Cifu DX, Taylor BC, Carne WF, et al. Traumatic brain injury, posttraumatic stress disorder, and pain diagnoses in OIF/OEF/OND Veterans. J Rehabil Res Dev. 2013;50(9):1169–76.CrossRefPubMed
31.
American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older P. Pharmacological management of persistent pain in older persons. Pain Med. 2009;10(6):1062–83.CrossRef
32.
Von Korff M, Kolodny A, Deyo RA, Chou R. Long-term opioid therapy reconsidered. Ann Intern Med. 2011;155(5):325–8.CrossRef
33.
Sullivan MD, Ballantyne JC. What are we treating with long-term opioid therapy? Arch Intern Med. 2012;172(5):433–4.CrossRefPubMed
34.
Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008;11(2 Suppl):S63–88.PubMed
35.
Nelson LS, Perrone J. Curbing the opioid epidemic in the United States: the risk evaluation and mitigation strategy (REMS). JAMA. 2012;308(5):457–8.CrossRefPubMed
36.
Kroenke K, Krebs E, Wu J, et al. Stepped Care to Optimize Pain care Effectiveness (SCOPE) trial study design and sample characteristics. Contemp Clin Trials. 2013;34(2):270–81.CrossRefPubMed
37.
Garg RK, Fulton-Kehoe D, Turner JA, et al. Changes in opioid prescribing for Washington workers’ compensation claimants after implementation of an opioid dosing guideline for chronic noncancer pain: 2004 to 2010. J Pain. 2013;14(12):1620–8.CrossRefPubMed
38.
Dobscha SK, Morasco BJ, Duckart JP, Macey T, Deyo RA. Correlates of prescription opioid initiation and long-term opioid use in veterans with persistent pain. Clin J Pain. 2013;29(2):102–8.CrossRefPubMedCentralPubMed
39.
Martin BC, Fan MY, Edlund MJ, Devries A, Braden JB, Sullivan MD. Long-term chronic opioid therapy discontinuation rates from the TROUP study. J Gen Intern Med. 2011;26(12):1450–7.CrossRefPubMedCentralPubMed
40.
Mosher HJ, Jiang L, Vaughan Sarrazin MS, Cram P, Kaboli PJ, Vander Weg MW. Prevalence and characteristics of hospitalized adults on chronic opioid therapy. J Hosp Med. 2014;9(2):82–7.CrossRefPubMedCentralPubMed
Metadata
Title
Trends in Prevalent and Incident Opioid Receipt: an Observational Study in Veterans Health Administration 2004–2012
Authors
H. J. Mosher, MFA, M.D.
E. E. Krebs, M.D., M.P.H.
M. Carrel, Ph.D.
P. J. Kaboli, M.D., M.S.
M. W. Vander Weg, Ph.D.
B.C. Lund, Pharm.D.
Publication date
01-05-2015
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 5/2015
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-014-3143-z

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