Reasons for discontinuation of long-term opioid therapy in patients with and without substance use disorders

Travis I. Lovejoy, Benjamin J. Morasco, Michael I. Demidenko, Thomas H A Meath, Joseph W. Frank, Steven K. Dobscha

Research output: Contribution to journalArticle

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Abstract

Several factors may accelerate opioid discontinuation rates, including lack of information about the long-term effectiveness of opioids for chronic pain, heightened awareness about opioid-related adverse events, closer monitoring of patients for opioid-related aberrant behaviors, and greater restrictions around opioid prescribing. Rates of discontinuation may be most pronounced in patients deemed to be at "high risk." The purpose of this study was to compare reasons for discontinuation of long-term opioid therapy (LTOT) between patients with and without substance use disorder (SUD) diagnoses receiving care within a major U.S. health care system. This retrospective cohort study assembled a cohort of Veterans Health Administration patients prescribed opioid therapy for at least 12 consecutive months who subsequently discontinued opioid therapy for at least 12 months. From this cohort, we randomly selected 300 patients with SUD diagnoses and propensity score-matched 300 patients without SUD diagnoses. A comprehensive manual review of patients' medical records ascertained reasons for LTOT discontinuation. Most patients (85%) were discontinued as a result of clinician, rather than patient, decisions. For patients whose clinicians initiated discontinuation, 75% were discontinued because of opioid-related aberrant behaviors. Relative to patients without SUD diagnoses, those with SUD diagnoses were more likely to discontinue LTOT because of aberrant behaviors (81% vs 68%), most notably abuse of alcohol or other substances. This is the first study to document reasons for discontinuation of LTOT in a sample of patients with and without SUD diagnoses. Treatments that concurrently address SUD and chronic pain are needed for this high-risk population.

LanguageEnglish (US)
Pages526-534
Number of pages9
JournalPain
Volume158
Issue number3
DOIs
StatePublished - 2017

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Opioid Analgesics
Substance-Related Disorders
Therapeutics
Chronic Pain
Veterans Health
Propensity Score
United States Department of Veterans Affairs
Physiologic Monitoring
Alcoholism
Medical Records
Cohort Studies
Retrospective Studies
Delivery of Health Care

Keywords

  • Chronic opioid therapy
  • Long-term opioid therapy
  • Opioid
  • Opioid discontinuation
  • Substance use disorder

ASJC Scopus subject areas

  • Pharmacology
  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Reasons for discontinuation of long-term opioid therapy in patients with and without substance use disorders. / Lovejoy, Travis I.; Morasco, Benjamin J.; Demidenko, Michael I.; Meath, Thomas H A; Frank, Joseph W.; Dobscha, Steven K.

In: Pain, Vol. 158, No. 3, 2017, p. 526-534.

Research output: Contribution to journalArticle

Lovejoy, Travis I. ; Morasco, Benjamin J. ; Demidenko, Michael I. ; Meath, Thomas H A ; Frank, Joseph W. ; Dobscha, Steven K./ Reasons for discontinuation of long-term opioid therapy in patients with and without substance use disorders. In: Pain. 2017 ; Vol. 158, No. 3. pp. 526-534
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