Clinician Referrals for Non-opioid Pain Care Following Discontinuation of Long-term Opioid Therapy Differ Based on Reasons for Discontinuation

Travis Lovejoy, Benjamin Morasco, Michael I. Demidenko, Thomas H.A. Meath, Steven Dobscha

Research output: Contribution to journalArticle

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Abstract

Background: Little is known about pain care offered to patients discontinued from long-term opioid therapy (LTOT) by their prescriber due to aberrant behaviors versus other reasons. Objective: This study aimed to compare rates of non-opioid analgesic pharmacotherapy initiation and clinician referrals for non-pharmacologic pain treatment, complementary and integrative pain therapies, and specialty mental health and substance use disorder treatment between patients discontinued from opioid therapy due to aberrant behaviors versus other reasons. Design: The design included retrospective manual electronic health record review and administrative data abstraction. Participants: Patients were sampled from a national cohort of US Department of Veterans Affairs patients prescribed continuous opioid therapy in 2011 who subsequently discontinued opioid therapy in 2012. The study sample comprised 509 patients discontinued from LTOT by opioid-prescribing clinicians. Main Measures: The primary independent variable was reason for discontinuation of LTOT (aberrant behaviors versus other reasons). Pain care dichotomous outcomes included clinician use of an opioid taper; initiating new non-opioid analgesic pharmacotherapy; and referrals for non-pharmacologic pain treatment, complementary and integrative pain therapies, and specialty mental health and substance use disorder treatment. Key Results: We observed low rates of opioid taper (15% of patients), initiations of new or modifications of existing non-opioid analgesic pharmacotherapy (45% of patients), and clinician referrals for non-pharmacologic pain treatment (58% of patients) and complementary and integrative therapies (25% of patients). Patients discontinued due to aberrant behaviors, relative to patients discontinued for other reasons, were more likely to receive opioid tapers (adjusted OR = 5.60, 95% CI = 2.10–14.93), receive new non-opioid analgesic medications or dose changes to an existing non-opioid analgesic medications (adjusted OR = 2.61, 95% CI = 1.59–4.29), or be referred for specialty substance use disorder treatment (adjusted OR = 7.39, 95% CI = 3.76–14.53). Conclusions: These findings highlight the variability in referral rates for different types of non-opioid pain treatments and challenges accessing specific types of pain care.

Original languageEnglish (US)
Pages (from-to)24-30
Number of pages7
JournalJournal of General Internal Medicine
Volume33
DOIs
StatePublished - May 1 2018

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Opioid Analgesics
Referral and Consultation
Pain
Analgesics
Therapeutics
Substance-Related Disorders
Drug Therapy
Mental Health
United States Department of Veterans Affairs
Behavior Therapy
Electronic Health Records
Complementary Therapies

ASJC Scopus subject areas

  • Internal Medicine

Cite this

@article{c6b3e11c5d514d02ac09d6184adee384,
title = "Clinician Referrals for Non-opioid Pain Care Following Discontinuation of Long-term Opioid Therapy Differ Based on Reasons for Discontinuation",
abstract = "Background: Little is known about pain care offered to patients discontinued from long-term opioid therapy (LTOT) by their prescriber due to aberrant behaviors versus other reasons. Objective: This study aimed to compare rates of non-opioid analgesic pharmacotherapy initiation and clinician referrals for non-pharmacologic pain treatment, complementary and integrative pain therapies, and specialty mental health and substance use disorder treatment between patients discontinued from opioid therapy due to aberrant behaviors versus other reasons. Design: The design included retrospective manual electronic health record review and administrative data abstraction. Participants: Patients were sampled from a national cohort of US Department of Veterans Affairs patients prescribed continuous opioid therapy in 2011 who subsequently discontinued opioid therapy in 2012. The study sample comprised 509 patients discontinued from LTOT by opioid-prescribing clinicians. Main Measures: The primary independent variable was reason for discontinuation of LTOT (aberrant behaviors versus other reasons). Pain care dichotomous outcomes included clinician use of an opioid taper; initiating new non-opioid analgesic pharmacotherapy; and referrals for non-pharmacologic pain treatment, complementary and integrative pain therapies, and specialty mental health and substance use disorder treatment. Key Results: We observed low rates of opioid taper (15{\%} of patients), initiations of new or modifications of existing non-opioid analgesic pharmacotherapy (45{\%} of patients), and clinician referrals for non-pharmacologic pain treatment (58{\%} of patients) and complementary and integrative therapies (25{\%} of patients). Patients discontinued due to aberrant behaviors, relative to patients discontinued for other reasons, were more likely to receive opioid tapers (adjusted OR = 5.60, 95{\%} CI = 2.10–14.93), receive new non-opioid analgesic medications or dose changes to an existing non-opioid analgesic medications (adjusted OR = 2.61, 95{\%} CI = 1.59–4.29), or be referred for specialty substance use disorder treatment (adjusted OR = 7.39, 95{\%} CI = 3.76–14.53). Conclusions: These findings highlight the variability in referral rates for different types of non-opioid pain treatments and challenges accessing specific types of pain care.",
author = "Travis Lovejoy and Benjamin Morasco and Demidenko, {Michael I.} and Meath, {Thomas H.A.} and Steven Dobscha",
year = "2018",
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doi = "10.1007/s11606-018-4329-6",
language = "English (US)",
volume = "33",
pages = "24--30",
journal = "Journal of General Internal Medicine",
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T1 - Clinician Referrals for Non-opioid Pain Care Following Discontinuation of Long-term Opioid Therapy Differ Based on Reasons for Discontinuation

AU - Lovejoy, Travis

AU - Morasco, Benjamin

AU - Demidenko, Michael I.

AU - Meath, Thomas H.A.

AU - Dobscha, Steven

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: Little is known about pain care offered to patients discontinued from long-term opioid therapy (LTOT) by their prescriber due to aberrant behaviors versus other reasons. Objective: This study aimed to compare rates of non-opioid analgesic pharmacotherapy initiation and clinician referrals for non-pharmacologic pain treatment, complementary and integrative pain therapies, and specialty mental health and substance use disorder treatment between patients discontinued from opioid therapy due to aberrant behaviors versus other reasons. Design: The design included retrospective manual electronic health record review and administrative data abstraction. Participants: Patients were sampled from a national cohort of US Department of Veterans Affairs patients prescribed continuous opioid therapy in 2011 who subsequently discontinued opioid therapy in 2012. The study sample comprised 509 patients discontinued from LTOT by opioid-prescribing clinicians. Main Measures: The primary independent variable was reason for discontinuation of LTOT (aberrant behaviors versus other reasons). Pain care dichotomous outcomes included clinician use of an opioid taper; initiating new non-opioid analgesic pharmacotherapy; and referrals for non-pharmacologic pain treatment, complementary and integrative pain therapies, and specialty mental health and substance use disorder treatment. Key Results: We observed low rates of opioid taper (15% of patients), initiations of new or modifications of existing non-opioid analgesic pharmacotherapy (45% of patients), and clinician referrals for non-pharmacologic pain treatment (58% of patients) and complementary and integrative therapies (25% of patients). Patients discontinued due to aberrant behaviors, relative to patients discontinued for other reasons, were more likely to receive opioid tapers (adjusted OR = 5.60, 95% CI = 2.10–14.93), receive new non-opioid analgesic medications or dose changes to an existing non-opioid analgesic medications (adjusted OR = 2.61, 95% CI = 1.59–4.29), or be referred for specialty substance use disorder treatment (adjusted OR = 7.39, 95% CI = 3.76–14.53). Conclusions: These findings highlight the variability in referral rates for different types of non-opioid pain treatments and challenges accessing specific types of pain care.

AB - Background: Little is known about pain care offered to patients discontinued from long-term opioid therapy (LTOT) by their prescriber due to aberrant behaviors versus other reasons. Objective: This study aimed to compare rates of non-opioid analgesic pharmacotherapy initiation and clinician referrals for non-pharmacologic pain treatment, complementary and integrative pain therapies, and specialty mental health and substance use disorder treatment between patients discontinued from opioid therapy due to aberrant behaviors versus other reasons. Design: The design included retrospective manual electronic health record review and administrative data abstraction. Participants: Patients were sampled from a national cohort of US Department of Veterans Affairs patients prescribed continuous opioid therapy in 2011 who subsequently discontinued opioid therapy in 2012. The study sample comprised 509 patients discontinued from LTOT by opioid-prescribing clinicians. Main Measures: The primary independent variable was reason for discontinuation of LTOT (aberrant behaviors versus other reasons). Pain care dichotomous outcomes included clinician use of an opioid taper; initiating new non-opioid analgesic pharmacotherapy; and referrals for non-pharmacologic pain treatment, complementary and integrative pain therapies, and specialty mental health and substance use disorder treatment. Key Results: We observed low rates of opioid taper (15% of patients), initiations of new or modifications of existing non-opioid analgesic pharmacotherapy (45% of patients), and clinician referrals for non-pharmacologic pain treatment (58% of patients) and complementary and integrative therapies (25% of patients). Patients discontinued due to aberrant behaviors, relative to patients discontinued for other reasons, were more likely to receive opioid tapers (adjusted OR = 5.60, 95% CI = 2.10–14.93), receive new non-opioid analgesic medications or dose changes to an existing non-opioid analgesic medications (adjusted OR = 2.61, 95% CI = 1.59–4.29), or be referred for specialty substance use disorder treatment (adjusted OR = 7.39, 95% CI = 3.76–14.53). Conclusions: These findings highlight the variability in referral rates for different types of non-opioid pain treatments and challenges accessing specific types of pain care.

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