Trajectories of Opioid Coverage After Long-Term Opioid Therapy Initiation Among a National Cohort of US Veterans

Corey J Hayes; Laura E Gressler; Bo Hu; Bobby L Jones; J Silas Williams; Bradley C Martin

doi:10.2147/JPR.S308196

Trajectories of Opioid Coverage After Long-Term Opioid Therapy Initiation Among a National Cohort of US Veterans

J Pain Res. 2021 Jun 14:14:1745-1762. doi: 10.2147/JPR.S308196. eCollection 2021.

Authors

Corey J Hayes^{1

2}, Laura E Gressler³, Bo Hu^{1

2}, Bobby L Jones⁴, J Silas Williams^{1

2}, Bradley C Martin⁵

Affiliations

¹ Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.
² Center of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
³ Department of Pharmaceutical Health Services Research, College of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA.
⁴ Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁵ Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Abstract

Purpose: The objective of this study was to identify the trajectories that patients take after initiating long-term opioid therapy (LTOT).

Materials and methods: Using a retrospective cohort design, veterans with chronic non-cancer pain (CNCP) initiating LTOT were identified. Group-based trajectory models were used to identify opioid therapy trajectories based on days of opioid supply (primary outcome) and average daily morphine milligram equivalent dose (AMME; secondary outcome) in each 180-day period following initiation of LTOT.

Results: A total of 438,398 veterans with CNCP initiated LTOT. Nine trajectories were identified: 33.7% with persistent, high days covered, 17.7% with persistent, moderate days covered, 16.6% with slow, persistent days-covered reduction, 2.4% with days-covered reduction followed by increase, 4.6% with delayed days-covered reduction, 4.1% with rapid days-covered reduction, 10.9% with moderate-paced discontinuation, 3.4% with delayed discontinuation, and 6.5% with rapid discontinuation. Patients following discontinuation trajectories were more likely to be younger, persons of color, use more supportive services (eg, physical therapy), and received less opioid days' supply and lower doses prior to initiating LTOT as compared to patients following persistent opioid days-covered trajectories. AMME trajectories were similar to days-covered trajectories.

Conclusion: Among persons initiating LTOT, nine opioid trajectories emerged which can be broadly characterized into three main trajectory groups: persistent opioid therapy (2 trajectories), reductions in opioid therapy (4 trajectories), and discontinuation (3 trajectories). A majority of patients (51.4%) maintained persistent opioid therapy. Further research is needed to assess the risks of opioid-related adverse outcomes among the identified trajectories.

Keywords: chronic non-cancer pain; group-based trajectory models; long-term opioid therapy; opioids; veterans.

Grants and funding

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R36DA046717. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Hayes was also supported by the National Institute on Drug Abuse under the Translational Training in Addiction Grant [1T32 DA 022981]. This material is the result of work supported with resources and the use of facilities at the Veterans Health Administration.