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Pharmacoepidemiol Drug Saf. 2018 Oct 30. doi: 10.1002/pds.4678. [Epub ahead of print]

Impact of initiatives to reduce prescription opioid risks on medically attended injuries in people using chronic opioid therapy.

Author information

1
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
2
Department of Epidemiology, University of Washington, Seattle, WA, USA.
3
Department of Biostatistics, University of Washington, Seattle, WA, USA.
4
Departments of Pharmacy and Health Services, University of Washington, Seattle, WA, USA.

Abstract

PURPOSE:

The purpose of the study is to determine whether initiatives to improve the safety of opioid prescribing decreased injuries in people using chronic opioid therapy (COT).

METHODS:

We conducted an interrupted time series analysis using data from Group Health (GH), an integrated health care delivery system in the United States. In 2007, GH implemented initiatives which substantially reduced daily opioid dose and increased patient monitoring. Among GH members age 18 or older receiving COT between 2006 and 2014, we compared injury rates for patients in GH's integrated group practice (IGP; exposed to the initiatives) vs patients cared for by contracted providers (not exposed). Injuries were identified using a validated algorithm. We calculated injury incidence during the baseline (preintervention) period from 2006 to 2007; the dose reduction period, 2008 to 2010; and the risk stratification and monitoring period, 2010 to 2014. Using modified Poisson regression, we estimated adjusted relative risks (RRs) representing the relative change per year in injury rates.

RESULTS:

Among 21 853 people receiving COT in the IGP and 8260 in contracted care, there were 2679 injuries during follow-up. The baseline injury rate was 1.0% per calendar quarter in the IGP and 0.9% in contracted care. Risk reduction initiatives did not decrease injury rates: Within the IGP, the RR in the dose reduction period was 1.01 (95% CI, 0.95-1.07) and in the risk stratification and monitoring period, 0.99 (95% CI, 0.95-1.04). Injury trends did not differ between the two care settings.

CONCLUSIONS:

Risk reduction initiatives did not decrease injuries in people using COT.

KEYWORDS:

chronic opioid therapy; fractures; guidelines; injuries; opioids; pharmacoepidemiology; risk reduction

PMID:
30375121
DOI:
10.1002/pds.4678

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