학술논문
Reasons for Opioid Discontinuation and Unintended Consequences Following Opioid Discontinuation Within the TOPCARE Trial
OPIOIDS & SUBSTANCE USE DISORDERS SECTION
OPIOIDS & SUBSTANCE USE DISORDERS SECTION
Document Type
Academic Journal
Author
Source
Pain Medicine. July 2019, Vol. 20 Issue 7, p1330, 8 p.
Subject
Language
English
ISSN
1526-2375
Abstract
Introduction In 2014, physicians prescribed chronic opioid therapy to an estimated one in 20 US adults [1]. In an effort to curb the ongoing opioid crisis, medical organizations and government [...]
Objective. To identify reasons for opioid discontinuation and post-discontinuation outcomes among patients in the Transforming Opioid Prescribing in Primary Care (TOPCARE) study. Design. In TOPCARE, an intervention to improve adherence to opioid prescribing guidelines, randomized intervention primary care providers (PCPs) received nurse care manager support, an electronic registry, academic detailing, and electronic tools, and control PCPs received electronic tools only. Setting. Four Boston safety net primary care practices. Subjects. Patients in both TOPCARE study arms who discontinued opioid therapy during the trial. Methods. Through chart review, we examined the reason for discontinuation and post-discontinuation outcomes: one or more PCP visits, one or more pain-related emergency department (ED) visits, evidence of opioid use disorder (OUD), and referral for OUD treatment. Results. Opioid discontinuations occurred in 83/586 (14.2%) intervention and 42/399 (10.5%) control patients (P = 0.09). Among patients who discontinued opioids, 81 (65%) discontinued for misuse, with no difference by group (P = 0.38). Aberrancy in monitoring (e.g., discordant urine drug test results) was the most common type of misuse prompting discontinuation (occurring in (51/83 [61%] of intervention patients vs 19/42 [45%, P = 0.08] of control patients). Intervention patients who discontinued opioids had less PCP follow-up (65% vs 88%, P Key Words: Opioids; Chronic Pain; Discontinuation; Discontinuing; Taper; TOPCARE
Objective. To identify reasons for opioid discontinuation and post-discontinuation outcomes among patients in the Transforming Opioid Prescribing in Primary Care (TOPCARE) study. Design. In TOPCARE, an intervention to improve adherence to opioid prescribing guidelines, randomized intervention primary care providers (PCPs) received nurse care manager support, an electronic registry, academic detailing, and electronic tools, and control PCPs received electronic tools only. Setting. Four Boston safety net primary care practices. Subjects. Patients in both TOPCARE study arms who discontinued opioid therapy during the trial. Methods. Through chart review, we examined the reason for discontinuation and post-discontinuation outcomes: one or more PCP visits, one or more pain-related emergency department (ED) visits, evidence of opioid use disorder (OUD), and referral for OUD treatment. Results. Opioid discontinuations occurred in 83/586 (14.2%) intervention and 42/399 (10.5%) control patients (P = 0.09). Among patients who discontinued opioids, 81 (65%) discontinued for misuse, with no difference by group (P = 0.38). Aberrancy in monitoring (e.g., discordant urine drug test results) was the most common type of misuse prompting discontinuation (occurring in (51/83 [61%] of intervention patients vs 19/42 [45%, P = 0.08] of control patients). Intervention patients who discontinued opioids had less PCP follow-up (65% vs 88%, P Key Words: Opioids; Chronic Pain; Discontinuation; Discontinuing; Taper; TOPCARE