Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: Observational evaluation
BMJ Mar 09, 2020
Oliva EM, Bowe T, Manhapra A, et al. - An observational evaluation was designed to explore the relationships between stopping treatment with opioids, length of treatment, and death from overdose or suicide in the Veterans Health Administration. Researchers recruited a total of 1,394,102 individuals in the Veterans Health Administration with an outpatient prescription for an opioid analgesic from the fiscal year 2013 to the end of the fiscal year 2014 (1 October 2012 to 30 September 2014). They applied a multivariable Cox non-proportional hazard regression model to analyze death from overdose or suicide, with the interaction of time-varying opioid cessation by the length of treatment (≤30, 31-90, 91-400, and > 400 days) as the main covariates. The study found 2,887 deaths from overdose or suicide. With an increase in the risk the longer patients had been treated before stopping, individuals were at greater risk of death from overdose or suicide after stopping opioid treatment. Descriptive data implied that starting treatment with opioids was also a risk period. Procedures to mitigate the risk in these periods are not currently a focus of guidelines for long term use of opioids. The relationships observed cannot be considered to be causal; the context in which opioid prescriptions were started and stopped might contribute to risk and be not examined. This study indicated that safer prescribing of opioids should take a broader view on patient safety and mitigate the risk from the patient’s perspective.
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