PMID- 29553279
OWN - NLM
STAT- MEDLINE
DCOM- 20191021
LR  - 20220318
IS  - 1936-2692 (Electronic)
IS  - 1088-0224 (Linking)
VI  - 24
IP  - 3
DP  - 2018 Mar 1
TI  - Trends in opioid and nonsteroidal anti-inflammatory use and adverse events.
PG  - e61-e72
AB  - OBJECTIVES: To describe the prevalence and incidence of opioid and nonsteroidal 
      anti-inflammatory drug (NSAID) use before and since the start of the Veterans 
      Health Administration (VHA) Opioid Safety Initiative (OSI) and to assess rates of 
      adverse events (AEs). STUDY DESIGN: Historical cohort study. METHODS: The OSI 
      began in August 2012 and was fully implemented by the end of fiscal year (FY) 
      2013. The study timeframe was categorized into baseline (FY 2011-2012), 
      transition (FY 2013), and postimplementation (FY 2014-2015) phases. Prevalence 
      and incidence rates were calculated for opioid and NSAID users by quarter between 
      FY 2011 and FY 2015. For AEs among new users of an NSAID or opioid, Cox 
      proportional hazards models with inverse probability weighting were used to 
      adjust for potential confounding. RESULTS: There were 3,315,846 regular users of 
      VHA care with at least 1 opioid and/or NSAID outpatient prescription between FYs 
      2011 and 2015. The quarterly opioid prevalence rate was approximately 21% during 
      the baseline and transition phases, then decreased to 17.3% in the 
      postimplementation phase. NSAID prevalence remained constant at about 16%. Opioid 
      incidence rates gradually decreased (2.7% to 2.2%) during the study, whereas 
      NSAID incidence rates remained about 2.2%. After inverse probability weighting, 
      patients receiving opioids had a greater risk of cardiovascular events (hazard 
      ratio [HR], 1.41; 95% CI, 1.36-1.47), acute kidney injury (HR, 2.60; 95% CI, 
      2.51-2.68), gastrointestinal bleeding (HR, 1.68; 95% CI, 1.56-1.81), and 
      all-cause mortality (HR, 3.73; 95% CI, 3.60-3.87) than NSAID users. CONCLUSIONS: 
      Opioid use declined following implementation of the OSI, whereas NSAID use 
      remained constant. Rates of AEs were higher among opioid users, which provides 
      additional rationale for efforts to use NSAIDs for pain management when 
      appropriate.
FAU - Fassio, Veronica
AU  - Fassio V
FAU - Aspinall, Sherrie L
AU  - Aspinall SL
AD  - VA Pittsburgh Healthcare System, University Dr (151C) Bldg 30, Pittsburgh, PA 
      15240. Email: sherrie.aspinall@va.gov.
FAU - Zhao, Xinhua
AU  - Zhao X
FAU - Miller, Donald R
AU  - Miller DR
FAU - Singh, Jasvinder A
AU  - Singh JA
FAU - Good, Chester B
AU  - Good CB
FAU - Cunningham, Francesca E
AU  - Cunningham FE
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20180301
PL  - United States
TA  - Am J Manag Care
JT  - The American journal of managed care
JID - 9613960
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Analgesics, Opioid/*adverse effects
MH  - Anti-Inflammatory Agents, Non-Steroidal/*adverse effects
MH  - Drug Utilization/statistics & numerical data
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Prevalence
MH  - Proportional Hazards Models
MH  - United States
MH  - United States Department of Veterans Affairs/*statistics & numerical data
MH  - Young Adult
EDAT- 2018/03/20 06:00
MHDA- 2019/10/23 06:00
CRDT- 2018/03/20 06:00
PHST- 2018/03/20 06:00 [entrez]
PHST- 2018/03/20 06:00 [pubmed]
PHST- 2019/10/23 06:00 [medline]
AID - 87495 [pii]
PST - epublish
SO  - Am J Manag Care. 2018 Mar 1;24(3):e61-e72.