Analysis of data from a national sample suggests that discontinuation of long-term use of opioid therapies is frequently abrupt and occurs without a tapering period. Living in regions with robust and strongly robust prescription drug monitoring programs (PDMPs) was found to increase the rate of opioid discontinuation without tapering. Researchers from Weill Cornell Medicine published their findings in the American Journal of Preventive Medicine.
The authors analyzed 2011-2017 claims from the Health Care Cost Institute database, which has information on about one-third of adults with private health insurance and about one-half of Medicare Advantage enrollees in the US. Gaps in opioid prescriptions of ≥30 days were considered long-term episodes of nonuse. PDMPs in different states were assessed for efficacy and compared with evidence of opioid discontinuation among residents of a given state.
PDMPs were assessed for 3 criteria: legislation for prescribers to use PDMPs, legislation allowing prescribers to delegate PDMP use to clinic staff, and state participation in the federal prescription monitoring program InterConnect. PDMPs with all 3 features were defined as strongly robust. Noncomprehensive use of mandates plus 2 of the 3 features was defined as robust. Nonrobust PDMPs did not have all 3 features.
The investigators observed 272,169 long-term discontinuations among 205,755 privately insured individuals aged 18-64 years and 296,954 long-term discontinuations among 195,438 Medicare Advantage enrollees aged ≥65 years.
In the privately insured vs Medicare cohorts, respectively, 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 9.1% had neck pain, and 79.6% and 87.5% had no evidence of opioid tapering.
Individuals who lived in areas with robust PDMPs were more likely to have a reduced daily morphine mg equivalent (DMME) dose during the month before discontinuation (relative increase, 4%; 95% CI, 1.4-6.7; P =.019). Individuals enrolled in Medicare Advantage in regions with strongly robust PDMPs had a decreased rate of discontinuing opioid use with a DMME dose ≥90 (relative decrease, 10.4%; 95% CI, 4.0-16.8; P =.010) or ≥120 (relative decrease, 17.3%; 95% CI, 9.2-25.3; P =.001).
Compared with nonrobust PDMPs, the investigators predicted that during the last month of use there would be a 4.0% and 0.4% increase in DMME ≥60, 0.9% and -3.7% change in DMME ≥90, and -1.5% and -5.6% decrease in DMME ≥120 among individuals covered by private insurance living in areas with robust and strongly robust PDMPs, respectively.
For the Medicare Advantage recipients, -0.6% and -4.8% decreases in DMME ≥60; -5.2% and -10.4% (P <.01) decreases in DMME ≥90; and -7.1% and -17.3% (P <.01) decreases in DMME ≥120 were predicted for individuals living in areas with robust and strongly robust PDMPs, respectively.
For all individuals, living in regions with robust and strongly robust PDMPs increased the rate of opioid discontinuation without tapering.
This study may have been limited by defining opioid discontinuation by a relatively short gap in use (30 days), according to the investigators.
These data indicate that strongly robust PDMPs may be preventing long-term opioid use from escalating to use of high opioid doses among the Medicare Advantage population, the authors wrote. Abrupt discontinuation of long-term opioid use without a tapering period may be of concern and should be investigated, they concluded.
Bao Y, Zhang H, Wen K, et al. Robust prescription monitoring programs and abrupt discontinuation of long-term opioid use. Am J Prev Med. Published online July 4, 2021. doi:10.1016/j.amepre.2021.04.019