Long-Term Chronic Opioid Therapy Discontinuation Rates from the TROUP Study
- 591 Downloads
To report chronic opioid therapy discontinuation rates after five years and identify factors associated with discontinuation.
Medical and pharmacy claims records from January 2000 through December 2005 from a national private health network (HealthCore), and Arkansas (AR) Medicaid were used to identify ambulatory adult enrollees who had 90 days of opioids supplied. Recipients were followed until they discontinued opioid prescription fills or disenrolled. Kaplan Meier survival models and Cox proportional hazards models were estimated to identify factors associated with time until opioid discontinuation.
There were 23,419 and 6,848 chronic opioid recipients followed for a mean of 1.9 and 2.3 years in the HealthCore and AR Medicaid samples. Over a maximum follow up of 4.8 years, 67.0% of HealthCore and 64.9% AR Medicaid recipients remained on opioids. Recipients on high daily opioid dose (greater than 120 milligrams morphine equivalent (MED)) were less likely to discontinue than recipients taking lower doses: HealthCore hazard ratio (HR) = 0.66 (95%CI: 0.57–0.76), AR Medicaid HR = 0.66 (95%CI: 0.50–0.82). Recipients with possible opioid misuse were also less likely to discontinue: HealthCore HR = 0.83 (95%CI: 0.78–0.89), AR Medicaid HR = 0.78 (95%CI: 0.67–0.90).
Over half of persons receiving 90 days of continuous opioid therapy remain on opioids years later. Factors most strongly associated with continuation were intermittent prior opioid exposure, daily opioid dose ≥ 120 mg MED, and possible opioid misuse. Since high dose and opioid misuse have been shown to increase the risk of adverse outcomes special caution is warranted when prescribing more than 90 days of opioid therapy in these patients.
KEY WORDSopioids opioid misuse persistence discontinuation
This research was supported by a grant from the National Institute on Drug Abuse DA022560 to Dr. Mark D. Sullivan. Dr. Jennifer Brennan Braden was supported by a Ruth L. Kirschstein National Research Service Award (NRSA) Institutional Research Training Grant [T32 MH20021 (Katon)]. Gary Moore provided invaluable programming support in preparing the analytic files from AR Medicaid. The Arkansas Department of Human Services, Division of Medical Services provided no-cost access to the AR Medicaid claims files. Dr. Andrea DeVries is an employee of HealthCore. Dr. Ming-Yu Fan is currently an employee of eBay. Dr. Bradley C. Martin is a consultant to Daiichi Sankyo for work unrelated to the current study. Dr. Mark D. Sullivan had full access to all of the data in the study and takes responsibility for the integrity of the data andthe accuracy of the data analysis.
Conflict of Interest
- 3.Sandner-Kiesling A, Leyendecker P, Hopp M, Tarau L, Lejcko J, Meissner W, Sevcik P, Hakl M, Hrib R, Uhl R, Dürr H, Reimer K. Long-term efficacy and safety of combined prolonged-release oxycodone and naloxone in the management of non-cancer chronic pain. Int J Clin Pract. 2010;64(6):763–74.PubMedCrossRefGoogle Scholar
- 15.Clinical Classification Software (CCS) for ICD-9 CM [computer program]. Version. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
- 17.SAS [computer program]. Version 9.1. Cary, NC: SAS Institute, Inc.Google Scholar
- 28.PRESCRIPTION DRUG ABUSE CRISIS. http://www.whitehousedrugpolicy.gov/publications/pdf/rx_abuse_plan.pdf (last accessed April 27, 2011).