Impact of Opioid Dose Reduction and Risk Mitigation Initiatives on Chronic Opioid Therapy Patients at Higher Risk for Opioid-Related Adverse Outcomes.
Pain Med
; 19(12): 2450-2458, 2018 12 01.
Article
em En
| MEDLINE
| ID: mdl-29220525
ABSTRACT
Objective:
We aimed to determine if opioid risk reduction initiatives including dose reduction and risk mitigation strategies for chronic noncancer pain patients receiving chronic opioid therapy (COT) had a differential impact on average daily opioid doses of COT patients at higher risk for opioid-related adverse outcomes compared with lower-risk patients.Design:
Interrupted time series.Setting:
Group Health Cooperative (GH), a health care delivery system and insurance within Washington State, between 2006 and 2014. Population GH enrollees on COT defined as receiving a supply of 70 or more days of opioids within 90 days using electronic pharmacy data for filled prescriptions.Methods:
We compared the average daily morphine equivalent doses (MED) of COT patients with and without each of the following higher-risk characteristics mental disorders, substance use disorders, sedative use, and male gender.Results:
In all four pairwise comparisons, the higher-risk subgroup had a higher average daily MED than the lower-risk subgroup across the study period. Adjusted for covariates, modest differences in the annual rate of reduction in average daily MED were noted between higher- and lower-risk subgroups in three pairwise comparisons those with mental disorders vs without (-8.2 mg/y vs -5.2 mg/y, P = 0.005), with sedative use vs without (-9.2 mg/y vs -5.8 mg/y, P = 0.004); mg), in men vs women (-8.8 mg/y vs -5.9 mg/y, P = 0.01).Conclusion:
Using clinical policy initiatives in a health care system, dose reductions were achieved among COT patients at higher risk for opioid-related adverse outcomes that were at least as large as those among lower-risk patients.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
/
2_ODS3
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8_ODS3_consumo_sustancias_psicoactivas
Base de dados:
MEDLINE
Assunto principal:
Dor Crônica
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Analgésicos Opioides
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Hipnóticos e Sedativos
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Transtornos Relacionados ao Uso de Opioides
Tipo de estudo:
Etiology_studies
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Guideline
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Pain Med
Ano de publicação:
2018
Tipo de documento:
Article