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New paper! Led by the great @hannahneprash along with stellar RA Marema Gaye.
In @JournalGIM we take a close look at how chronic opioid users in Medicare have had their therapy discontinued from 2012-2017. We find some disturbing results ...
https://rdcu.be/cetTq
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In @JournalGIM we take a close look at how chronic opioid users in Medicare have had their therapy discontinued from 2012-2017. We find some disturbing results ...
https://rdcu.be/cetTq
/1
Very limited research out there on discontinuation of opioid therapy. But there are still MILLIONS of people on long-term therapy.
People like @StefanKertesz @maiasz @PoojaLagisetty and many others have been ringing alarm bells about the stigma and peril this group faces.
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People like @StefanKertesz @maiasz @PoojaLagisetty and many others have been ringing alarm bells about the stigma and peril this group faces.
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We wanted to know:
1) who is getting long-term opioid therapy discontinued
2) how quickly is discontinuation happening?
3) Is discontinuation increasing?
This matters because we don't know the magnitude of how opioids are de-prescribed, so policy is in the dark.
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1) who is getting long-term opioid therapy discontinued
2) how quickly is discontinuation happening?
3) Is discontinuation increasing?
This matters because we don't know the magnitude of how opioids are de-prescribed, so policy is in the dark.
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We used national Medicare data from 2012-2017 and identified >250,000 long-term opioid users who had at least 12 months of sustained rx fills.
Who is getting long-term therapy discontinued? More likely if you are male, on Medicaid and on a lower daily dose of opioids.
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Who is getting long-term therapy discontinued? More likely if you are male, on Medicaid and on a lower daily dose of opioids.
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Now the disturbing part. We looked at how QUICKLY people were taken off their therapy. We used a very permissive cutoff for what could be an "acceptable" taper speed.
Tapering was "abrupt" if someone still had >50% of the baseline dose the month before the last prescription.
Tapering was "abrupt" if someone still had >50% of the baseline dose the month before the last prescription.
We found that no matter the daily opioid dose, from low to very high, >60% of users had an abrupt taper, dropping by more than half their baseline dose in one month.
This Figure shows how few opioid users crossed the 50% dose threshold in the 6 months before their last rx.
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This Figure shows how few opioid users crossed the 50% dose threshold in the 6 months before their last rx.
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The % of long-term opioid users discontinued increased 50% from 2012-2017, from 5.7% annually to 8.5%.
Of these discontinuations, 70% were abrupt in 2012 and 81% we abrupt in 2017 - it went UP!
The steepest increase in discontinuation was among disabled Medicare enrollees.
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Of these discontinuations, 70% were abrupt in 2012 and 81% we abrupt in 2017 - it went UP!
The steepest increase in discontinuation was among disabled Medicare enrollees.
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So, TL;DR:
- There are many older adults on long-term opioids
- When they have therapy discontinued, it is WAY too fast for safety for most.
- This pattern only got worse over time.
Thanks to @RRFAging for their support of this important work
https://rdcu.be/cetTq
/fin
- There are many older adults on long-term opioids
- When they have therapy discontinued, it is WAY too fast for safety for most.
- This pattern only got worse over time.
Thanks to @RRFAging for their support of this important work
https://rdcu.be/cetTq
/fin
