Demographic, Social, Behavioral, and Clinical Characteristics Associated with Long-Term Opioid Therapy and Any Opioid Prescription in High-Risk VA Patients

doi:10.1007/s11606-024-09125-7

. 2024 Oct 22.

doi: 10.1007/s11606-024-09125-7. Online ahead of print.

Demographic, Social, Behavioral, and Clinical Characteristics Associated with Long-Term Opioid Therapy and Any Opioid Prescription in High-Risk VA Patients

Dan V Blalock^{1

2}, Liberty Greene^{3

4}, Ryan M Kane^{5

6}, Valerie A Smith^{1

5

7}, Josephine Jacobs^{3

8}, Mayuree Rao^{9

10}, Alicia J Cohen^{11

12

13}, Donna M Zulman^{3

4}, Matthew L Maciejewski^{14

15

16}

Affiliations

¹ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA.
² Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
³ Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.
⁴ Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
⁵ Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA.
⁶ Clinical and Translational Science Institute, Duke University, Durham, NC, USA.
⁷ Department of Population Health Sciences, Duke University, Durham, NC, USA.
⁸ Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA.
⁹ Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.
¹⁰ Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
¹¹ Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA.
¹² Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.
¹³ Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI, USA.
¹⁴ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA. [email protected].
¹⁵ Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA. [email protected].
¹⁶ Department of Population Health Sciences, Duke University, Durham, NC, USA. [email protected].

PMID: 39438381
DOI: 10.1007/s11606-024-09125-7

Demographic, Social, Behavioral, and Clinical Characteristics Associated with Long-Term Opioid Therapy and Any Opioid Prescription in High-Risk VA Patients

Dan V Blalock et al. J Gen Intern Med. 2024.

. 2024 Oct 22.

doi: 10.1007/s11606-024-09125-7. Online ahead of print.

Authors

Affiliations

¹ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA.
² Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
³ Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.
⁴ Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
⁵ Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA.
⁶ Clinical and Translational Science Institute, Duke University, Durham, NC, USA.
⁷ Department of Population Health Sciences, Duke University, Durham, NC, USA.
⁸ Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA.
⁹ Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.
¹⁰ Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
¹¹ Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA.
¹² Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.
¹³ Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI, USA.
¹⁴ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA. [email protected].
¹⁵ Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA. [email protected].
¹⁶ Department of Population Health Sciences, Duke University, Durham, NC, USA. [email protected].

PMID: 39438381
DOI: 10.1007/s11606-024-09125-7

Abstract

Background: Social risks (individual social and economic conditions) have been implicated as playing a major role in the opioid epidemic and may be more prevalent in the most medically vulnerable patients. However, the extent to which specific social risks and other patient factors are associated with opioid use among high-risk patients has not been comprehensively assessed.

Objective: To identify patient-reported and electronic health record (EHR)-derived demographic, social, behavioral/psychological, and clinical characteristics associated with opioid use in Veterans Affairs (VA) patients at high risk for hospitalization or death.

Design: We used generalized estimating equations to calculate the probability of long-term opioid therapy (LTOT) and the probability of filling any opioid prescription (regardless of duration) over five intervals during a 4-year period (12/2016-12/2020).

Participants: Prospective cohort of 4121 medically high-risk VA patients not receiving palliative or end-of-life care, and who responded to a survey mailed to a nationally representative sample of 10,000 high-risk VA patients.

Main measures: Patient-reported demographic, social risk, behavioral/psychological, and clinical measures, and linked EHR-derived data.

Key results: The average age was 69.8 years, 6.7% were female, and 17.5% were Non-Hispanic Black race/ethnicity. The majority had diagnosed chronic pain (76.1%). LTOT and any opioid prescription were positively associated with the following: younger age, non-Hispanic White race/ethnicity (compared to non-Hispanic Black race/ethnicity), male sex assigned at birth (LTOT only), not being currently employed, current tobacco use, no alcohol use, higher grit (any opioid prescription only), functional limitations, diagnosed chronic pain, lower comorbidity burden (LTOT only), obesity class I or class II/III (any opioid prescription only), undergoing surgery (any opioid prescription only), and diagnosed cancer (any opioid prescription only).

Conclusions: Multifactor screening could help identify individuals at elevated risk for adverse opioid-related outcomes and augment current multifaceted initiatives, as several social risks and patient characteristics were predictors of LTOT and any opioid prescription.

Keywords: Veterans; long-term opioid therapy; opioid use; social determinants of health; social risks.

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References

1. Hadlandsmyth K, Mosher H, Vander Weg MW, Lund BC. Decline in prescription opioids attributable to decreases in long-term use: a retrospective study in Veterans Health Administration 2010–2016. J Gen Intern Med. https://doi.org/10.1007/s11606-017-4283-8 .
1. Gellad WF, Good CB, Shulkin DJ. Addressing the opioid epidemic in the United States: lessons from the Department of Veterans Affairs. JAMA Intern Med. 2017;177(5):611-2. - DOI - PubMed
1. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624-45. - DOI - PubMed - PMC
1. Higgins C, Smith BH and Matthews K. Incidence of iatrogenic opioid dependence or abuse in patients with pain who were exposed to opioid analgesic therapy: a systematic review and meta-analysis. Br J Anaesth. 2018;120:1335–1344. - DOI - PubMed
1. Sandbrink F, Oliva EM, McMullen TL, et al. Opioid prescribing and opioid risk mitigation strategies in the Veterans Health Administration. J Gen Intern Med. 2020;35(Suppl 3):927-934. https://doi.org/10.1007/s11606-020-06258-3 . - DOI - PubMed - PMC

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[1] Hadlandsmyth K, Mosher H, Vander Weg MW, Lund BC. Decline in prescription opioids attributable to decreases in long-term use: a retrospective study in Veterans Health Administration 2010–2016. J Gen Intern Med. https://doi.org/10.1007/s11606-017-4283-8 .

[2] Hadlandsmyth K, Mosher H, Vander Weg MW, Lund BC. Decline in prescription opioids attributable to decreases in long-term use: a retrospective study in Veterans Health Administration 2010–2016. J Gen Intern Med. https://doi.org/10.1007/s11606-017-4283-8 .

[3] Gellad WF, Good CB, Shulkin DJ. Addressing the opioid epidemic in the United States: lessons from the Department of Veterans Affairs. JAMA Intern Med. 2017;177(5):611-2. - DOI - PubMed

[4] Gellad WF, Good CB, Shulkin DJ. Addressing the opioid epidemic in the United States: lessons from the Department of Veterans Affairs. JAMA Intern Med. 2017;177(5):611-2. - DOI - PubMed

[5] Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624-45. - DOI - PubMed - PMC

[6] Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624-45. - DOI - PubMed - PMC

[7] Higgins C, Smith BH and Matthews K. Incidence of iatrogenic opioid dependence or abuse in patients with pain who were exposed to opioid analgesic therapy: a systematic review and meta-analysis. Br J Anaesth. 2018;120:1335–1344. - DOI - PubMed

[8] Higgins C, Smith BH and Matthews K. Incidence of iatrogenic opioid dependence or abuse in patients with pain who were exposed to opioid analgesic therapy: a systematic review and meta-analysis. Br J Anaesth. 2018;120:1335–1344. - DOI - PubMed

[9] Sandbrink F, Oliva EM, McMullen TL, et al. Opioid prescribing and opioid risk mitigation strategies in the Veterans Health Administration. J Gen Intern Med. 2020;35(Suppl 3):927-934. https://doi.org/10.1007/s11606-020-06258-3 . - DOI - PubMed - PMC

[10] Sandbrink F, Oliva EM, McMullen TL, et al. Opioid prescribing and opioid risk mitigation strategies in the Veterans Health Administration. J Gen Intern Med. 2020;35(Suppl 3):927-934. https://doi.org/10.1007/s11606-020-06258-3 . - DOI - PubMed - PMC

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Demographic, Social, Behavioral, and Clinical Characteristics Associated with Long-Term Opioid Therapy and Any Opioid Prescription in High-Risk VA Patients

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Demographic, Social, Behavioral, and Clinical Characteristics Associated with Long-Term Opioid Therapy and Any Opioid Prescription in High-Risk VA Patients

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