Veterans Health Administration Taeko Minegishi, MS - - PowerPoint PPT Presentation

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Sep 29, 2023 193 likes •381 views

Opioid Tapering at the Veterans Health Administration Taeko Minegishi, MS Taeko.Minegishi@va.gov VETERANS HEALTH ADMINISTRATION Collaborators & Disclaimers Office of Mental Health and Suicide Prevention Office VA Pharmacy Benefits

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VETERANS HEALTH ADMINISTRATION

Opioid Tapering at the Veterans Health Administration

Taeko Minegishi, MS Taeko.Minegishi@va.gov

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VETERANS HEALTH ADMINISTRATION

Collaborators & Disclaimers

Office of Mental Health and Suicide Prevention Office VA Pharmacy Benefits Management Partners Evidence-based Policy Resource Center

Melissa Garrido, PhD
Steven Pizer, PhD
Austin Frakt, PhD

The contents of this presentation do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

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VETERANS HEALTH ADMINISTRATION

Opioid Tapering

Assist Primary Care providers in:

determining if an opioid taper is necessary
performing the taper
providing follow-up and support during the taper

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VETERANS HEALTH ADMINISTRATION

Objective

How prevalent is long-term high-dose opioid patients in VHA?

>90 days continuous and >90 MEDD

Do we see opioid tapering in the VHA? Are there unintended consequences of opioid tapering?

serious adverse events and overdose death

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VETERANS HEALTH ADMINISTRATION

Why VHA?

High risk vulnerable population

Mental health
Chronic pain

Data advantage

National Healthcare System (128 VHA medical stations)
Long-term prescription data for patients who use any of the VHA medical centers
Match hospital utilization and patient diagnosis

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VETERANS HEALTH ADMINISTRATION

Cohort Definitions

FY13 (baseline) : N= 1.4 million patients Any opioid prescription N = 53,799 At least 90 days of prescription and > 90 MEDD N = 43,539 Exclude if any inpatient admission, metastatic cancer, hospice, or palliative care

N = 35,138 At least one 90 days continuous prescription

Followed their opioid prescriptions through FY16

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VETERANS HEALTH ADMINISTRATION

Prevalence of Long-term High-dose Opioid Patients

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VETERANS HEALTH ADMINISTRATION

Length of Opioid Prescription

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VETERANS HEALTH ADMINISTRATION

Opioid Prescription Trends

To zero
To zero and back
Always decreasing
Always increasing
Others

N To zero To zero and back Always decreasing Always Increasing Others 35,138 8,727 703 6,288 1,386 18,034 25% 2% 18% 4% 51%

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VETERANS HEALTH ADMINISTRATION

Always Decreasing

To zero
To zero and back
Always decreasing
Always increasing
Others

N To zero To zero and back Always decreasing Always Increasing Others 35,138 8,727 703 6,288 1,386 18,034 25% 2% 18% 4% 51%

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VETERANS HEALTH ADMINISTRATION

Always Decreasing: Annual MEDD Trend

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VETERANS HEALTH ADMINISTRATION

Always Decreasing: % Decrease per year

~ 22% per year

Some evidence that higher MEDD patients reduce faster?

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VETERANS HEALTH ADMINISTRATION

Geographic Variation in Fast Taper

Fast tapering could be dangerous for high dose patients Tapering of >22% per year is common

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VETERANS HEALTH ADMINISTRATION

To zero

To zero
To zero and back
Always decreasing
Always increasing
Others

N To zero To zero and back Always decreasing Always Increasing Others 35,138 8,727 703 6,288 1,386 18,034 25% 2% 18% 4% 51%

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VETERANS HEALTH ADMINISTRATION

To Zero: Deceased

47% of patients were reported deceased (cause of death unknown at this point)

30% died within 6 months

f their last prescription date

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VETERANS HEALTH ADMINISTRATION

Main Findings

How prevalent is long-term high-dose opioid patients in VHA?

On average 2.8% of patients are long-term high-dose opioid patients in each VHA

medical centers Do we see opioid tapering in the VHA?

18% of patients MEDD consistently decreased over 4 years

– Some evidence that higher MEDD patients reduce faster – Tapering >22% per year is common

Are there unintended consequences of opioid tapering?

25% of patients tapered to zero and ~50% of patients deceased during/post

prescription periods

Causal direction is unknown

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VETERANS HEALTH ADMINISTRATION

Next Steps

Analysis with shorter time intervals: quarterly and monthly
Cause of death
Link with outcomes: overdose death and serious adverse events
Explore the “others” group (>50%)

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VETERANS HEALTH ADMINISTRATION