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

  • Travis I. Lovejoy
  • Benjamin J. Morasco
  • Michael I. Demidenko
  • Thomas H. A. Meath
  • Steven K. Dobscha
Original Research

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.

Notes

Acknowledgements

This work was supported by Locally Initiated Project Award no. QLP 59-048 (PI: Lovejoy) from the US Department of Veterans Affairs Substance Use Disorder Quality Enhancement Research Initiative. Dr. Lovejoy received additional support from Career Development Award IK2HX001516 from the US Department of Veterans Affairs Health Services Research and Development during preparation of this manuscript. We thank the VA Portland Health Care System and the US Department of Veterans Affairs Health Services Research and Development Center to Improve Veteran Involvement in Care (CIVIC; CIN 13-404, PI: Dobscha) at the VA Portland Health Care System for the provision of support and resources for this project.

Compliance with Ethical Standards

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or U.S. Government.

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Society of General Internal Medicine (outside the USA) 2018

Authors and Affiliations

  • Travis I. Lovejoy
    • 1
    • 2
    • 3
  • Benjamin J. Morasco
    • 1
    • 2
  • Michael I. Demidenko
    • 1
  • Thomas H. A. Meath
    • 1
    • 4
  • Steven K. Dobscha
    • 1
    • 2
  1. 1.Center to Improve Veteran Involvement in Care, VA Portland Health Care SystemPortlandUSA
  2. 2.Department of PsychiatryOregon Health and Science UniversityPortlandUSA
  3. 3.School of Public HealthOregon Health and Science UniversityPortlandUSA
  4. 4.Center for Health Systems EffectivenessOregon Health and Science UniversityPortlandUSA

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