2018 Issues   /   Pharmacy

Long-term Opioid Prescribing Declines in VHA, Bucking National Trend

By Brenda Mooney

Extended Prescribing Dropped from 9.5% in 2012 to 6.2% in 2016

By Brenda L. Mooney

IOWA CITY, IA—Long-term prescribing of opioid painkillers is on the decline at the VA, in contrast to what appears to be happening outside of federal medicine.

A new study in the Journal of General Internal Medicine reports that overall opioid prescribing has fallen from a peak in 2012, primarily because of long-term prescribing has dropped. Study authors led by Katherine Hadlandsmyth, PhD, of the Iowa City, IA, VA Healthcare System and the University of Iowa pointed out that longer-term opioid use creates much more opportunity for harmful side effects, compared with short-term use.1

Study authors also emphasized that studies of healthcare in the United States outside of the VHA demonstrate decreases in short-term opioid prescriptions but not long-term ones.

Long-term Opioid Prescribing Declines in VHA

Veterans Dispensed at Least 1 Opioid Medication in the VA Health Care System and Percent of Opioid Recipients With Concurrent Benzodiazepine Prescriptions and High Opioid DosageData are from VA Pharmacy Benefits Management Services and presented by quarter, fiscal years 2003 through 2016.

Hadlandsmyth suggested that other healthcare systems could learn from the VHA example, adding, “Future work to understand precisely which initiatives have most positively impacted opioid prescribing would be necessary to maintain effective approaches within VHA.” See related Pharmacy Update, p. xx

For the study, researchers analyzed VHA prescription data from 2010 to 2016, which included more than four million veterans per year. They found that, in 2010, opioids were prescribed at least once to 20.8%—962,193 out of around 4.63 million—VA patients. Six years later, the percentage had declined to 16.1, representing 803,888 of 4.99 million veterans who received outpatient prescriptions for opioid products such as hydrocodone, oxycodone and fentanyl.

Drilling down into the results, study authors found that long-term use accounted for about 90% of VHA opioid prescriptions during the study period. That decreased, however, from 9.5% in 2012, to 6.2% in 2016.

Hadlandsmyth suggested that was not because many existing long-term users stopped taking opioids but because fewer veterans receiving new opioid prescriptions ultimately became long-term opioid users. The data backed her up, with the likelihood of a veteran becoming a new long-term opioid user falling overall from 2.8% in 2011 to 1.1% in 2016.

“The prevalence of opioid prescribing was 20.8% in 2010, peaked at 21.2% in 2012, and declined annually to 16.1% in 2016,” the researchers wrote. “Between 2010 and 2016, reductions in long-term opioid prescribing accounted for 83% of the overall decline in opioid prescription fills. Comparing data from 2010-2011 to data from 2015-2016, declining rates in new long-term use accounted for more than 90% of the decreasing prevalence of long-term opioid use in the VHA, whereas increases in cessation among existing long-term users accounted for less than 10%. The relative risk of transitioning to long-term use during 2016 was 6.5 (95% CI: 6.4, 6.7) among short-term users and 35.5 (95% CI: 34.8, 36.3) among intermediate users, relative to patients with no opioid prescriptions filled during 2015.”


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