• Travis I Lovejoy, Benjamin J Morasco, Michael I Demidenko, Meath Thomas H A THA Center to Improve Veteran Involvement in Care,, VA Portland Health Care System, Portland, OR, USA. , and Steven K Dobscha.
• Center to Improve Veteran Involvement in Care,, VA Portland Health Care System, Portland, OR, USA. travis.lovejoy@va.gov.
• J Gen Intern Med. 2018 May 1; 33 (Suppl 1): 24-30.

BackgroundLittle is known about pain care offered to patients discontinued from long-term opioid therapy (LTOT) by their prescriber due to aberrant behaviors versus other reasons.ObjectiveThis study aimed to compare rates of non-opioid analgesic pharmacotherapy initiation and clinician referrals for non-pharmacologic pain treatment, complementary and integrative pain therapies, and specialty mental health and substance use disorder treatment between patients discontinued from opioid therapy due to aberrant behaviors versus other reasons.DesignThe design included retrospective manual electronic health record review and administrative data abstraction.ParticipantsPatients were sampled from a national cohort of US Department of Veterans Affairs patients prescribed continuous opioid therapy in 2011 who subsequently discontinued opioid therapy in 2012. The study sample comprised 509 patients discontinued from LTOT by opioid-prescribing clinicians.Main MeasuresThe primary independent variable was reason for discontinuation of LTOT (aberrant behaviors versus other reasons). Pain care dichotomous outcomes included clinician use of an opioid taper; initiating new non-opioid analgesic pharmacotherapy; and referrals for non-pharmacologic pain treatment, complementary and integrative pain therapies, and specialty mental health and substance use disorder treatment.Key ResultsWe observed low rates of opioid taper (15% of patients), initiations of new or modifications of existing non-opioid analgesic pharmacotherapy (45% of patients), and clinician referrals for non-pharmacologic pain treatment (58% of patients) and complementary and integrative therapies (25% of patients). Patients discontinued due to aberrant behaviors, relative to patients discontinued for other reasons, were more likely to receive opioid tapers (adjusted OR = 5.60, 95% CI = 2.10-14.93), receive new non-opioid analgesic medications or dose changes to an existing non-opioid analgesic medications (adjusted OR = 2.61, 95% CI = 1.59-4.29), or be referred for specialty substance use disorder treatment (adjusted OR = 7.39, 95% CI = 3.76-14.53).ConclusionsThese findings highlight the variability in referral rates for different types of non-opioid pain treatments and challenges accessing specific types of pain care.

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