Analysis of data from a national sample suggests that discontinuation of long-term use of opioid therapies is often abrupt, with no phase-out. Living in regions with robust and highly robust Prescription Drug Monitoring (PDMPs) programs has been found to increase opioid dropout rates without tapering. Weill Cornell Medicine researchers published their results in the American Journal of Preventive Medicine.
The authors analyzed 2011-2017 claims from the Health Care Cost Institute database, which contains information on about one-third of adults with private health insurance and about half of Medicare Advantage members in the United States. Opioid prescription gaps of ≥ 30 days were considered long-term episodes of non-use. PDMPs in different states were tested for effectiveness and compared with indications of opioid discontinuation in residents of a particular state.
PDMPs were rated on three criteria: legislation for prescribers to use PDMP, legislation allowing prescribers to delegate the use of PDMP to clinical staff, and government involvement in the state’s InterConnect prescription monitoring program. PDMPs with all 3 characteristics were defined as strongly robust. The insufficient use of mandates plus 2 of the 3 functions was defined as robust. Non-robust PDMPs did not have all 3 functions.
Investigators observed 272,169 long-term drop-outs in 205,755 privately insured people aged 18-64 and 296,954 long-term drop-outs in 195,438 Medicare Advantage members aged ≥65 years.
In the privately insured vs. Medicare cohorts, 54.7% and 65.6% were women, 43.0% and 50.8% had arthritis pain, 38.9% and 34.3% had back pain, 16.2% and 9, respectively , 1% neck pain and 79.6% and 87.5% had no evidence of tapering opioids.
Individuals living in areas with robust PDMPs were more likely to have a reduced daily morphine mg equivalent dose (DMME) (relative increase 4%; 95% CI 1.4–6.7; p = 0.019) in the month prior to weaning. Individuals enrolled in Medicare Advantage in regions with highly robust PDMPs had decreased opioid abandonment rates with a DMME dose of ≥ 90 (relative decrease, 10.4%; 95% CI, 4.0-16.8 ; p = .010) or ≥ 120 (relative.) on decrease, 17.3%; 95% CI, 9.2-25.3; P = 0.001).
Compared to non-robust PDMPs, the researchers predicted that in the last month of use there would be a 4.0% increase in DMME 60 or a decrease in DMME ≥120 for privately insured individuals living in areas with robust and highly robust PDMPs, respectively .
Medicare Advantage recipients, DMME 60 decreases by -0.6% and -4.8%; -5.2% and -10.4% (P <0.01) decreases for DMME ≥ 90; and -7.1% and -17.3% (P <0.01) decreases in DMME ≥ 120 were predicted for individuals living in areas with robust and highly robust PDMPs, respectively.
All individuals living in regions with robust and highly robust PDMPs had an increased opioid withdrawal rate without tapering.
This study may have been constrained by defining opioid discontinuation by a relatively short tablet-free break (30 days), the researchers said.
These data suggest that highly robust PDMPs may prevent long-term opioid use from escalating to high opioid doses in the Medicare Advantage population, the authors wrote. Abrupt cessation of long-term opioid use without tapering off may be a cause for concern and should be investigated, they concluded.
Y. Bao, H. Zhang, K. Wen et al. Robust prescription monitoring programs and abrupt cessation of long-term opioid use. Bin J Back Med. Published online on July 4, 2021. doi: 10.1016 / j.amepre.2021.04.019
This article originally appeared on Clinical Pain Advisor