A Typology of New Long-term Opioid Prescribing in the Veterans Health Administration
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Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA; 2Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; 3Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; 4University of Iowa, College of Public Health, Iowa City, IA, USA.
BACKGROUND: Narrow definitions of long-term opioid (LTO) use result in limited knowledge of the full range of LTO prescribing patterns and the rates of these patterns. OBJECTIVE: To investigate a model of new LTO prescribing typologies using latent class analysis. DESIGN: National administrative data from the VA Corporate Data Warehouse were accessed using the VA Informatics and Computing Infrastructure. Characterization of the typology of initial LTO prescribing was explored using latent class analysis. PARTICIPANTS: Veterans initiating LTO during 2016 through the Veteran’s Administration Healthcare System (N = 42,230). MAIN MEASURES: Opioid receipt as determined by VA prescription data, using the cabinet supply methodology. KEY RESULTS: Over one-quarter (27.7%) of the sample fell into the fragmented new long-term prescribing category, 39.8% were characterized by uniform daily new LTO, and the remaining 32.7% were characterized by uniform episodic LTO. Each of these three broad sub-groups also included two additional sub-groups (6 classes total in the model), characterized by the presence or absence of prior opioid prescriptions. CONCLUSIONS: New LTO prescribing in the VA includes uniform daily prescribing, uniform episodic prescribing, and fragmented prescribing. Future work is needed to elucidate the safety and efficacy of these prescribing patterns. KEY WORDS: long-term opioid; veteran; incidence. J Gen Intern Med DOI: 10.1007/s11606-020-05749-7 © Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2020
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-05749-7) contains supplementary material, which is available to authorized users. Received November 5, 2019 Revised January 31, 2020 Accepted February 14, 2020
INTRODUCTION
The widely applied definition for the time frame in which opioid use becomes long-term is more than 90 days.1–7 However, the regularity of use within and beyond this period is less clear. For example, the joint Veteran’s Affairs and Department of Defense guidelines describe patients on long-term therapy as receiving “daily therapy,” whereas the Center for Disease Control (CDC) guidelines describe “use on most days.” This difference may be trivial if the overwhelming majority of patients in real-world practice settings who receive opioids over extended time periods exhibit daily or near-daily use. However, applying operational criteria allowing gaps between prescriptions of up to 50% (a minimal interpretation of “most days”) yield rates of long-term opioid (LTO
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