The Journal of Pain Summary
Highlight from The Journal of Pain (Volume 20, No. 1, January 2019 Issue)
Impact of Chronic Opioid Therapy Risk Reduction Initiatives on Opioid Overdose
Michael Rehn Von Korff, Kathleen Saunders, Sascha Dublin, Rod L. Walker, Manu Thakral, Karen S. Sherman, Evette L. Ludman, Ryan N. Hans, Michael Parchman, Susan M. Shortreed
This study assessed effects of opioid dose and risk-reduction initiatives on overdose rates among chronic opioid therapy (COT) patients. Comparisons were made between patients in settings with a COT dose reduction initiative and risk stratification/monitoring initiative and patients in control settings. The findings represent the first controlled examination of opioid dose reduction and risk-based monitoring initiatives in reducing opioid overdose among COT patients.
The evaluation was conducted among subjects enrolled in 26 group practice clinics (intervention setting), compared to enrollees from diverse contracted care practices (controls). A retrospective analysis model was used, with an interrupted time series design to assess trends in opioid overdose.
From 2006 to 2014, 31,142 COT patients experienced 311 fatal or nonfatal opioid overdoses. Changes in overdose rates among COT patients did not differ significantly between intervention and control settings, with implementation of either dose reduction or risk stratification/monitoring. In planned secondary analyses, overdose rates declined significantly (17% per year) during the dose reduction initiative among COT patients in intervention settings.
The authors have concluded that overdose rates among COT patients were not reduced by risk stratification and monitoring initiatives. Results were inconsistent for COT dose reduction, with no significant difference between intervention and control settings (primary hypothesis test), but a significant decline in overdose rates was seen within the intervention setting during dose reduction (secondary hypothesis test).