Why Opioids Are Discontinued in VHA Patients

PORTLAND, OR — Discontinuation of opioids can be accelerated for several reasons, according to a new study, including lack of information about the long-term effectiveness of opioids for chronic pain, heightened awareness about opioid-related adverse events, closer monitoring of patients for opioid-related aberrant behaviors, and greater restrictions around opioid prescribing.

That’s especially the case in patients considered “high risk,” noted the article published recently in the journal Pain.1

The study led by researchers from the Center to Improve Veteran Involvement in Care at the VA Portland, OR, Healthcare System sought to compare reasons for discontinuation of long-term opioid therapy (LTOT) between patients with and without substance use disorder (SUD) diagnoses receiving care within the VHA.

The retrospective cohort study involved a cohort of veteran patients prescribed opioid therapy for at least 12 consecutive months who subsequently discontinued opioid therapy for at least 12 months. From the cohort, researchers randomly selected 300 patients with SUD diagnoses and propensity score-matched 300 patients without SUD diagnoses.

Used to determine reasons for LTOT discontinuation was a comprehensive manual review of patients’ medical records. Results indicated that most patients (85%) were discontinued because of clinician, rather than patient, decisions.

For patients whose clinicians initiated discontinuation, 75% were discontinued because of opioid-related aberrant behaviors. Compared to patients without SUD diagnoses, those with SUD diagnoses were more likely to discontinue LTOT because of aberrant behaviors — 81% vs. 68% — usually abuse of alcohol or other substances.

“This is the first study to document reasons for discontinuation of LTOT in a sample of patients with and without SUD diagnoses,” study authors wrote. “Treatments that concurrently address SUD and chronic pain are needed for this high-risk population.”

  1. Lovejoy TI, Morasco BJ, Demidenko MI, Meath TH, Frank JW, Dobscha SK. Reasons for discontinuation of long-term opioid therapy in patients with and without substance use disorders. Pain. 2017 Mar;158(3):526-534. doi: 10.1097/j.pain.0000000000000796. PubMed PMID: 28192376.

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