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The Association Between Receipt of Guideline-Concordant Long-Term Opioid Therapy and All-Cause Mortality.
- Source :
- JGIM: Journal of General Internal Medicine; May2016, Vol. 31 Issue 5, p492-501, 10p
- Publication Year :
- 2016
-
Abstract
- <bold>Purpose: </bold>For patients receiving long-term opioid therapy (LtOT), the impact of guideline-concordant care on important clinical outcomes--notably mortality--is largely unknown, even among patients with a high comorbidity and mortality burden (e.g., HIV-infected patients). Our objective was to determine the association between receipt of guideline-concordant LtOT and 1-year all-cause mortality.<bold>Methods: </bold>Among HIV-infected and uninfected patients initiating LtOT between 2000 and 2010 through the Department of Veterans Affairs, we used Cox regression with time-updated covariates and propensity-score matched analyses to examine the association between receipt of guideline-concordant care and 1-year all-cause mortality.<bold>Results: </bold>Of 17,044 patients initiating LtOT between 2000 and 2010, 1048 patients (6%) died during 1 year of follow-up. Patients receiving psychotherapeutic co-interventions (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.51-0.75; P < 0.001) or physical rehabilitative therapies (HR 0.81; 95% CI 0.67-0.98; P = 0.03) had a decreased risk of all-cause mortality compared to patients not receiving these services, whereas patients prescribed benzodiazepines concurrent with opioids had a higher risk of mortality (HR 1.39; 95% CI 1.12-1.66; P < 0.001). Among patients with a current substance use disorder (SUD), those receiving SUD treatment had a lower risk of mortality than untreated patients (HR 0.47; 95% CI 0.32-0.68; P = < 0.001). No association was found between all-cause mortality and primary care visits (HR 1.12; 95% CI 0.90-1.26; P = 0.32) or urine drug testing (HR 0.96; 95% CI 0.78-1.17; P = 0.67).<bold>Conclusions: </bold>Providers should use caution in initiating LtOT in conjunction with benzodiazepines and untreated SUDs. Patients receiving LtOT may benefit from multi-modal treatment that addresses chronic pain and its associated comorbidities across multiple disciplines. [ABSTRACT FROM AUTHOR]
- Subjects :
- DRUG therapy
OPIOIDS
MORTALITY
COMORBIDITY
MEDICAL rehabilitation
BENZODIAZEPINES
SUBSTANCE abuse treatment
TRANQUILIZING drugs
ANALGESICS
COMBINATION drug therapy
CHRONIC pain
COMPARATIVE studies
DATABASES
DRUG administration
HIV infections
RESEARCH methodology
MEDICAL cooperation
MEDICAL protocols
NARCOTICS
RESEARCH
RESEARCH funding
SUBSTANCE abuse
EVALUATION research
KAPLAN-Meier estimator
Subjects
Details
- Language :
- English
- ISSN :
- 08848734
- Volume :
- 31
- Issue :
- 5
- Database :
- Complementary Index
- Journal :
- JGIM: Journal of General Internal Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 114603323
- Full Text :
- https://doi.org/10.1007/s11606-015-3571-4