Observational studyJournal of general internal medicine2020
Opioid Discontinuation Among Patients Receiving High-Dose Long-Term Opioid Therapy in the Veterans Health Administration.
Observational study in Journal of general internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 18 citations in OpenAlex.
- Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial.The American journal of psychiatry · 2024Trial
- Factors associated with long-term opioid therapy discontinuation for people with chronic non-cancer pain in UK primary care: a population-based retrospective cohort study.British journal of anaesthesia · 2026Article
- Article
- Discontinuation of psychotropic medication: a synthesis of evidence across medication classes.Molecular psychiatry · 2024Review
- Patient Perspectives on Mental Health and Pain Management Support Needed Versus Received During Opioid Deprescribing.The journal of pain · 2024Article
- Trajectories of prescription opioid tapering in patients with chronic non-cancer pain: a retrospective cohort study, 2015-2020.Pain medicine (Malden, Mass.) · 2024Article
- Observational
- Opioid Dose Trajectories and Associations With Mortality, Opioid Use Disorder, Continued Opioid Therapy, and Health Plan Disenrollment.JAMA network open · 2022Article
- Dose tapering, increases, and discontinuity among patients on long-term high-dose opioid therapy in the United States, 2017-2019.Drug and alcohol dependence · 2022Observational
- Educational Intervention for Management of Acute Trauma Pain: A Proof-of-Concept Study in Post-surgical Trauma Patients.Frontiers in psychiatry · 2022Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPrior opioid discontinuation studies have focused on one of two characteristics of opioid prescribing, its duration (long term vs not) or dosage (high vs low). Questions remain about the experience of patients with high-dose, long-term opioid therapy (HLOT) prescriptions who are likely to be at the highest risk for adverse events.
objectiveWe address the following questions among the Veterans Health Administration (VHA) patients receiving HLOT: 1), How has the prevalence of discontinuation of opioids changed over time? 2), How do patient characteristics vary between those who do and do not discontinue? And 3), how does the prevalence of discontinuation vary geographically?
designA retrospective observational study of VHA patients with HLOT between fiscal year (FY) 2014 and FY2018.
participantsWe identified 1,281,330 patients from VHA outpatient opioid prescription data with at least a 1-day opioid supply between FY2014 and FY2018. We identified and excluded those receiving palliative care or diagnosed with metastatic cancer. MAIN MEASURES: For a given patient and month, a patient having a 3-month moving average of ≥ 90 daily morphine milligram equivalent (MME) was defined as having HLOT. Similarly, we used a three-month average MME of zero as discontinuation. KEY
resultsThe prevalence of discontinuation among patients with HLOT increased from 6.3% in FY2014 to 7.8% in FY2018. Across the years, patients who discontinued were younger, less likely to be married, and more likely to have comorbidities related to substance use disorders compared with patients who continued to receive HLOT. Incidence of discontinuation among those with HLOT increased in more than half (64%) of the 129 VHA medical centers.
conclusionPrevalence of patients receiving HLOT in the VHA decreased as the incidence of discontinuation increased. Further research is needed to understand the process by which patients are discontinued and to assess the relationship between discontinuation and health outcomes.
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