Emergency Physician Opioid Prescribing and Risk of Long-term Use in the Veterans Health Administration: an Observational Analysis
Treatment by high-opioid prescribing physicians in the emergency department (ED) is associated with higher rates of long-term opioid use among Medicare beneficiaries. However, it is unclear if this result is true in other high-risk populations such as Veterans.
To estimate the effect of exposure to high-opioid prescribing physicians on long-term opioid use for opioid-naïve Veterans.
Observational study using Veterans Health Administration (VA) encounter and prescription data.
Setting and Participants
Veterans with an index ED visit at any VA facility in 2012 and without opioid prescriptions in the prior 6 months in the VA system (“opioid naïve”).
We assigned patients to emergency physicians and categorized physicians into within-hospital quartiles based on their opioid prescribing rates. Our primary outcome was long-term opioid use, defined as 6 months of days supplied in the 12 months subsequent to the ED visit. We compared rates of long-term opioid use among patients treated by high versus low quartile prescribers, adjusting for patient demographic, clinical characteristics, and ED diagnoses.
We identified 57,738 and 86,393 opioid-naïve Veterans managed by 362 and 440 low and high quartile prescribers, respectively. Patient characteristics were similar across groups. ED opioid prescribing rates varied more than threefold between the low and high quartile prescribers within hospitals (6.4% vs. 20.8%, p < 0.001). The frequency of long-term opioid use was higher among Veterans treated by high versus low quartile prescribers, though above the threshold for statistical significance (1.39% vs. 1.26%; adjusted OR 1.11, 95% CI 0.997–1.24, p = 0.056). In subgroup analyses, there were significant associations for patients with back pain (adjusted OR 1.25, 95% CI 1.01–1.55, p = 0.04) and for those with a history of depression (adjusted OR 1.28, 95% CI 1.08–1.51, p = 0.004).
ED physician opioid prescribing varied by over 300% within facility, with a statistically non-significant increased rate of long-term use among opioid-naïve Veterans exposed to the highest intensity prescribers.
KEY WORDSopioid emergency prescribing Veteran
This study is financially supported by a grant from VA Health Services Research & Development (HSR&D) I01 HX001765-01 to Dr. Gellad.
Compliance with Ethical Standards
This study was approved by the institutional review board at the VA Pittsburgh Healthcare System.
Conflict of Interest
Dr. Barnett receives consulting fees unrelated to this work from Greylock McKinnon Associates Inc. and serves as a paid expert witness for plaintiffs in lawsuits against opioid manufacturers and distributors. The authors have no other conflicts of interest to disclose.
This work represents the opinions of the authors alone and does not necessarily represent the views of the Department of Veterans Affairs, the National Institute on Aging, or the US Government.
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