Abstract:
BACKGROUND:Between 2012 and 2017, the United States dramatically reduced opioid prescribing rates. While this may be appropriate given the opioid epidemic, there has been little research to guide the clinical practice of discontinuing patients from opioid medications and opioid death rates have continued to increase. OBJECTIVE:To determine the relationship between time to opioid discontinuation and the risk of an opioid-related emergency department visit or hospitalization among high dose opioid users. DESIGN:We applied Cox proportional hazard models to 2013-2017 Medicaid claims data to research this relationship. PARTICIPANTS:Medicaid beneficiaries in Vermont who filled prescription opioids at high daily doses (at least 120 morphine milligram equivalents) for 90 or more consecutive days and who subsequently discontinued opioid prescriptions (n = 494). MAIN MEASURES:The outcome was an opioid-related adverse event defined as an emergency department visit or hospitalization with a primary or secondary diagnosis of opioid poisoning or substance use disorder. KEY RESULTS:The median length of time to discontinuation was 1 day indicating that half of patients had no dose reduction prior to discontinuation. 86% of patients discontinued within 21 days (considered rapid tapering in recent clinical guidelines). 49% of members had an opioid-related hospitalization or emergency department visit. After controlling for sociodemographic and clinical factors, each additional week of discontinuation time was associated with a 7% reduction in the probability of having opioid related adverse event (p < 0.01). Although 60% of members had a diagnosed substance use disorder prior to tapering, <1% of beneficiaries were transitioned onto an opioid use disorder medication. CONCLUSIONS:Faster rates of opioid tapering were associated with a greater probability of adverse events and many patients discontinued opioids suddenly, with no dose reduction. Additional clinical guidance, research, and interventions are needed to ensure that patients' opioid prescriptions are discontinued safely.
journal_name
J Subst Abuse Treatjournal_title
Journal of substance abuse treatmentauthors
Mark TL,Parish Wdoi
10.1016/j.jsat.2019.05.001subject
Has Abstractpub_date
2019-08-01 00:00:00pages
58-63eissn
0740-5472issn
1873-6483pii
S0740-5472(19)30037-6journal_volume
103pub_type
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journal_title:Journal of substance abuse treatment
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journal_title:Journal of substance abuse treatment
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journal_title:Journal of substance abuse treatment
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journal_title:Journal of substance abuse treatment
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journal_title:Journal of substance abuse treatment
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journal_title:Journal of substance abuse treatment
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journal_title:Journal of substance abuse treatment
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journal_title:Journal of substance abuse treatment
pub_type: 杂志文章,随机对照试验
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journal_title:Journal of substance abuse treatment
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journal_title:Journal of substance abuse treatment
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journal_title:Journal of substance abuse treatment
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pub_type: 杂志文章
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journal_title:Journal of substance abuse treatment
pub_type: 杂志文章
doi:10.1016/j.jsat.2015.11.005
更新日期:2016-03-01 00:00:00
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journal_title:Journal of substance abuse treatment
pub_type: 杂志文章
doi:10.1016/j.jsat.2019.12.005
更新日期:2020-03-01 00:00:00
abstract::The use of naltrexone results in an accelerated opiate withdrawal. By combining clonidine with naltrexone, severity of the withdrawal is modified. This paper describes the author's experience with use of this protocol in 55 episodes of opiate detoxification. Commercially available naltrexone (Trexan) and clonidine tab...
journal_title:Journal of substance abuse treatment
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journal_title:Journal of substance abuse treatment
pub_type: 杂志文章
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pub_type: 杂志文章,评审
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journal_title:Journal of substance abuse treatment
pub_type: 杂志文章
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journal_title:Journal of substance abuse treatment
pub_type: 杂志文章
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journal_title:Journal of substance abuse treatment
pub_type: 杂志文章
doi:10.1016/j.jsat.2007.08.012
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journal_title:Journal of substance abuse treatment
pub_type: 杂志文章,评审
doi:10.1016/j.jsat.2008.05.007
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journal_title:Journal of substance abuse treatment
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/S0740-5472(03)00166-1
更新日期:2004-03-01 00:00:00
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journal_title:Journal of substance abuse treatment
pub_type: 杂志文章,多中心研究,随机对照试验
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pub_type: 杂志文章
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journal_title:Journal of substance abuse treatment
pub_type: 临床试验,杂志文章,随机对照试验
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