PMID- 34163232
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220424
IS  - 1178-7090 (Print)
IS  - 1178-7090 (Electronic)
IS  - 1178-7090 (Linking)
VI  - 14
DP  - 2021
TI  - Trajectories of Opioid Coverage After Long-Term Opioid Therapy Initiation Among a 
      National Cohort of US Veterans.
PG  - 1745-1762
LID - 10.2147/JPR.S308196 [doi]
AB  - 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.
CI  - (c) 2021 Hayes et al.
FAU - Hayes, Corey J
AU  - Hayes CJ
AD  - Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans 
      Healthcare System, North Little Rock, AR, USA.
AD  - Center of Health Services Research, Department of Psychiatry, College of 
      Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
FAU - Gressler, Laura E
AU  - Gressler LE
AD  - Department of Pharmaceutical Health Services Research, College of Pharmacy, 
      University of Maryland Baltimore, Baltimore, MD, USA.
FAU - Hu, Bo
AU  - Hu B
AD  - Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans 
      Healthcare System, North Little Rock, AR, USA.
AD  - Center of Health Services Research, Department of Psychiatry, College of 
      Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
FAU - Jones, Bobby L
AU  - Jones BL
AD  - Department of Psychiatry, University of Pittsburgh School of Medicine, 
      Pittsburgh, PA, USA.
FAU - Williams, J Silas
AU  - Williams JS
AD  - Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans 
      Healthcare System, North Little Rock, AR, USA.
AD  - Center of Health Services Research, Department of Psychiatry, College of 
      Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
FAU - Martin, Bradley C
AU  - Martin BC
AD  - Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University 
      of Arkansas for Medical Sciences, Little Rock, AR, USA.
LA  - eng
PT  - Journal Article
DEP - 20210614
PL  - New Zealand
TA  - J Pain Res
JT  - Journal of pain research
JID - 101540514
PMC - PMC8214015
OTO - NOTNLM
OT  - chronic non-cancer pain
OT  - group-based trajectory models
OT  - long-term opioid therapy
OT  - opioids
OT  - veterans
COIS- Dr. Martin receives royalties from TrestleTree LLC for the commercialization of 
      an opioid risk prediction tool, which is unrelated to the current study. Dr. 
      Martin is a paid consultant for eMaxHealth Systems for unrelated projects; also 
      serves as a member of the Midwest CEPAC of ICER and receives compensation for 
      reviews for work unrelated to this study. The remaining authors have no conflicts 
      of interest to declare.
EDAT- 2021/06/25 06:00
MHDA- 2021/06/25 06:01
PMCR- 2021/06/14
CRDT- 2021/06/24 06:30
PHST- 2021/02/24 00:00 [received]
PHST- 2021/05/01 00:00 [accepted]
PHST- 2021/06/24 06:30 [entrez]
PHST- 2021/06/25 06:00 [pubmed]
PHST- 2021/06/25 06:01 [medline]
PHST- 2021/06/14 00:00 [pmc-release]
AID - 308196 [pii]
AID - 10.2147/JPR.S308196 [doi]
PST - epublish
SO  - J Pain Res. 2021 Jun 14;14:1745-1762. doi: 10.2147/JPR.S308196. eCollection 2021.