The Association Between Receipt of Guideline-Concordant Long-Term Opioid Therapy and All-Cause Mortality |
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Authors: | Julie R. Gaither William C. Becker Stephen Crystal E. Jennifer Edelman Kirsha Gordon Robert D. Kerns David Rimland Melissa Skanderson Amy C. Justice |
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Affiliation: | 1.Yale School of Public Health,Yale University,New Haven,USA;2.VA Connecticut Healthcare System,West Haven,USA;3.Yale Center for Medical Informatics, Yale School of Medicine,Yale University,New Haven,USA;4.Center for Interdisciplinary Research on AIDS, Yale School of Public Health,Yale University,New Haven,USA;5.Department of Psychiatry, Yale School of Medicine,Yale University,New Haven,USA;6.Department of Internal Medicine, Yale School of Medicine,Yale University,New Haven,USA;7.Institute for Health, Health Care Policy, and Aging Research,Rutgers University,New Brunswick,USA;8.Division of Infectious Diseases,Emory University School of Medicine,Atlanta,USA;9.Atlanta VA Medical Center,Decatur,USA;10.VA Pittsburgh Healthcare System,Pittsburgh,USA |
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Abstract: | PurposeFor 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.MethodsAmong 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.ResultsOf 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).ConclusionsProviders 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. |
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