Nav: Home

Long-term opioid use has dropped among US military veterans

January 30, 2018

A new study in the Journal of General Internal Medicine, published by Springer, shows that opioid prescribing has dropped after a peak in 2012. Lead author Katherine Hadlandsmyth of the Iowa City VA Healthcare System and the University of Iowa in the US further noted that the decline was mostly due to decreases in long-term opioid prescribing, which carries much greater risk for harmful side effects, addiction and overdose, relative to short-term prescribing. In contrast, studies of general US health care outside the VHA have shown decreases in short-term opioid use, but potential increases in long-term use.

Hadlandsmyth and her team analyzed VHA prescription data from 2010 to 2016, which included more than four million veterans per year. In 2010, opioids were prescribed at least once to 20.8 percent (962,193 out of around 4.63 million) of them. By 2016, this figure dropped to 16.1 percent (803,888 of 4.99 million) of veterans who received outpatient prescriptions for opioid products such as hydrocodone, oxycodone and fentanyl.

After describing overall opioid prescribing, more detailed examination of the data focused on long-term opioid use, which accounted for about 90 percent of VHA opioid prescriptions during the study period. This analysis revealed a decrease in the percentage of veterans who received long-term opioid treatment in the VHA system from 9.5 percent in 2012, to 6.2 percent in 2016. According to Hadlandsmyth, this was not because many existing long-term users stopped taking opioids, but principally because fewer veterans receiving new opioid prescriptions went on to become long-term opioid users. The likelihood of a veteran becoming a new long-term opioid user decreased overall from 2.8 percent in 2011 to 1.1 percent in 2016.

Hadlandsmyth argues that the improved prescribing patterns might be the result of recent initiatives by the VHA emphasizing opioid safety and non-opioid alternatives for chronic pain treatment. Since 2010, VHA has provided clinical practice guidelines to medical practitioners about how best to use opioids to manage chronic pain, and how to select and monitor patients. These guidelines include suggestions on how to wean patients off opioid medications if treatment goals are not reached.

The VHA now also considers complementary treatments and multimodal therapy options for pain management, including behavioral, chiropractic and stepped care. In addition, the VA Opioid Safety Initiative implemented in 2013 sets out specific clinical safety targets aimed at reducing high-dose opioid use and concurrent benzodiazepine prescription, as well as the monitoring of patients via urine drug screens and inspection of state prescription drug monitoring databases.

"Future work to understand precisely which initiatives have most positively impacted opioid prescribing would be necessary to maintain effective approaches within VHA," adds Hadlandsmyth, who further believes that other healthcare systems might learn from the VHA example.
-end-
Reference: Hadlandsmyth, K. et al (2018). Decline in prescription opioids attributable to decreases in long-term use: a retrospective study in Veterans Health Administration 2010-2016, Journal of General Internal Medicine DOI: 10.1007/s11606-017-4283-8

Springer

Related Health Care Articles:

Care management program reduced health care costs in Partners Pioneer ACO
Pesearchers at Partners HealthCare published a study showing that Partners Pioneer ACO not only reduces spending growth, but does this by reducing avoidable hospitalizations for patients with elevated but modifiable risks.
Health care leaders predict patients will lose under President Trump's health care plans
According to a newly released NEJM Catalyst Insights Report, health care executives and industry insiders expect patients -- more than any other stakeholder -- to be the big losers of any comprehensive health care plan from the Trump administration.
The Lancet: The weaponisation of health care: Using people's need for health care as a weapon of war over six years of Syrian conflict
Marking six years since the start of the Syrian conflict (15 March), a study in The Lancet provides new estimates for the number of medical personnel killed: 814 from March 2011 to February 2017.
In the January Health Affairs: Brazil's primary health care expansion
The January issue of Health Affairs includes a study that explores a much-discussed issue in global health: the role of governance in improving health, which is widely recognized as necessary but is difficult to tie to actual outcomes.
Advocacy and community health care models complement research and clinical care
Global lung cancer researchers and patient advocates today emphasized that new models of delivering care and communicating about cancer care play an important role in the fight against lung cancer.
About 1 million Texans gained health care coverage due to Affordable Care Act
Texas has experienced a roughly 6 percentage-point increase in health insurance coverage from the Affordable Care Act, according to new research by experts at Rice University and the Episcopal Health Foundation.
In India, training informal health-care providers improved quality of care
Training informal health-care providers in India improved the quality of health care they offered to patients in rural regions, a new study reports.
Affordable Care Act has improved access to health care, but disparities persist
The Affordable Care Act has substantially decreased the number of uninsured Americans and improved access to health care, though insurance affordability and disparities by geography, race/ethnicity, and income persist.
Integrated team-based care shows potential for improving health care quality, use and costs
Among adults enrolled in an integrated health care system, receipt of primary care at integrated team-based care practices compared with traditional practice management practices was associated with higher rates of some measures of quality of care, lower rates for some measures of acute care utilization, and lower actual payments received by the delivery system, according to a study appearing in the Aug.
Study finds quality of care in VA health care system compares well to other settings
The quality of health care provided to US military veterans in Veterans Affairs (VA) facilities compares favorably with the treatment and services delivered outside the VA.

Related Health Care Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Moving Forward
When the life you've built slips out of your grasp, you're often told it's best to move on. But is that true? Instead of forgetting the past, TED speakers describe how we can move forward with it. Guests include writers Nora McInerny and Suleika Jaouad, and human rights advocate Lindy Lou Isonhood.
Now Playing: Science for the People

#527 Honey I CRISPR'd the Kids
This week we're coming to you from Awesome Con in Washington, D.C. There, host Bethany Brookshire led a panel of three amazing guests to talk about the promise and perils of CRISPR, and what happens now that CRISPR babies have (maybe?) been born. Featuring science writer Tina Saey, molecular biologist Anne Simon, and bioethicist Alan Regenberg. A Nobel Prize winner argues banning CRISPR babies won’t work Geneticists push for a 5-year global ban on gene-edited babies A CRISPR spin-off causes unintended typos in DNA News of the first gene-edited babies ignited a firestorm The researcher who created CRISPR twins defends...