LITTLE ROCK, AR — While discontinuing chronic opioid therapy in veterans appears to be associated with decreased diagnoses for opioid-related adverse outcomes, the association with substance use disorders appears to be inconclusive, according to a new study.
Writing in the journal Addiction, researchers from the Central Arkansas Veterans Healthcare System and the University of Arkansas for Medical Sciences and colleagues point out, “Prescribers are commonly confronted with discontinuing opioid therapy among patients prescribed chronic opioid therapy (COT). This study aimed to measure the association between discontinuing COT and diagnoses of substance use disorders (SUDs) and opioid-related adverse outcomes (AOs).”1
The retrospective cohort study involved about 16,000 VHA patients with chronic pain on COT who discontinued opioid therapy, comparing them with about 17,000 veterans continuing COT using data from fiscal years 2009-2015.
The study team tracked:
- Newly diagnosed substance use disorders (SUD composite; individual types: opioid, non-opioid drug, and alcohol use disorders);
- Opioid-related adverse outcomes (AO composite; individual types: accidents resulting in wounds/injuries;
- Opioid-related accidents/overdoses;
- Alcohol and non-opioid medication-related accidents/overdoses;
- Self-inflicted injuries; and
- Violence-related injuries.
In the primary propensity score-matched analyses, researchers found that the composite SUD outcome did not vary much between those discontinuing and those continuing COT (odds ratio (OR)=0.932, 95% confidence interval (CI): 0.850, 1.022).
Results indicated that the composite AO outcome was lower, however, among those discontinuing, (OR=0.660, 95%CI: 0.623, 0.699) compared with those continuing COT. Some analyses found lower SUD (OR=0.789, 95%CI: 0.743, 0.837), and AO (OR=0.660, 95%CI: 0.623, 0.699) rates among those discontinuing, while others had mixed results.
A study last year by some of the same researchers sought to understand the potential harmful effects of dose escalation among patients with chronic, non-cancer pain (CNCP) on chronic opioid therapy.2
In that study, veterans with CNCP and on chronic opioid therapy were identified using data from fiscal years 2008-15. Overall, 32,420 maintainers and 20,767 escalators, resulting in 19,358 (93.2%) matched pairs, were identified.
The study team found that composite AOs [odds ratio (OR) = 1.31, 95% confidence interval (CI) = 1.23, 1.40], composite SUDs (OR = 1.31, 95% CI = 1.22, 1.41) and individual SUD and AO subtypes were higher among dose escalators, except for opioid-related accidents and overdoses and violence-related injuries. Sensitivity analyses identified similar results to the primary analyses for all outcomes except opioid-related accidents and overdoses; those were found to be significantly higher among escalators.
“Escalating the opioid dose for those with chronic, non-cancer pain is associated with increased risks of substance use disorder and opioid-related adverse outcomes,” the authors concluded.
- Hayes CJ, Krebs EE, Li C, Brown J, Hudson T, Martin BC. Association between Discontinuing Chronic Opioid Therapy and Newly Diagnosed Substance Use Disorders, Accidents, Self-Inflicted Injuries and Drug Overdoses within the Prescribers’ Health Care System: A Retrospective Cohort Study. Addiction. 2021 Sep 13. doi: 10.1111/add.15689. Epub ahead of print. PMID: 34514677.
- Hayes CJ, Krebs EE, Hudson T, Brown J, Li C, Martin BC. Impact of opioid dose escalation on the development of substance use disorders, accidents, self-inflicted injuries, opioid overdoses and alcohol and non-opioid drug-related overdoses: a retrospective cohort study. Addiction. 2020 Jun;115(6):1098-1112. doi: 10.1111/add.14940. Epub 2020 Jan 15. PMID: 31944486; PMCID: PMC7263736.