• Am J Prev Med · Feb 2023

    Chronic and Sustained High-Dose Opioid Use in an Integrated Health System.

    • Rulin C Hechter, Katherine J Pak, Craig K Chang, Fagen Xie, Patricia L Gray, Deborah S Ling Grant, Joanna L Barreras, and Hui Zhou.
    • Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California. Electronic address: Rulin.C.Hechter@kp.org.
    • Am J Prev Med. 2023 Feb 1; 64 (2): 167174167-174.

    IntroductionThe Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain released in 2016 had led to decreases in opioid prescribing. This study sought to examine chronic and sustained high-dose prescription opioid use in an integrated health system.MethodsA serial cross-sectional study was conducted in 2021 to estimate the annual age-adjusted prevalence and incidence of chronic and high-dose opioid use among demographically diverse noncancer adults in an integrated health system in Southern California during 2013-2020. Interrupted time-series analysis with segmented regression was conducted to estimate changes in the trends in annual rates before (2013-2015) and after (2017-2020) the 2016 guideline, treating 2016 as a wash-out period.ResultsPrevalence and incidence of chronic use and sustained high-dose use had started to decrease after a health system intervention program before the 2016 Centers for Disease Control and Prevention guideline release and continued to decline after the guideline. Among those with sustained high-dose use, there was a substantial decrease in persons with an average daily dosage ≥90 morphine milligram equivalent and concurrent benzodiazepine use. An accelerated decrease in prevalent chronic use after the guideline was observed (slope change: -11.1 [95% CI= -20.3, -1.9] users/10,000 person-years, p=0.03). The incidence of chronic use and sustained high-dose use continued to decrease after the guideline release but at a slower pace.ConclusionsImplementing evidence-based prescribing guidelines was associated with a decrease in chronic and sustained high-dose prescription opioid use.Copyright © 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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