Data-Based Opioid Risk Review in Patients with Chronic Pain: A Retrospective Chart Review

Abstract

A retrospective, cohort, single center, chart review was conducted to compare rates of opioid-associated serious adverse events (SAEs) in a patient cohort 6 months before and 6 months after data-based opioid risk review. The primary objective was the composite reduction in opioid-related SAEs including suicide-related events and opioid overdoses. The impact of the reviews was assessed via multivariate logistic regression and a McNemar’s test to analyze difference in rates of opioid-associated SAEs. This study demonstrates that data-based opioid risk review can reduce opioid-related SAEs, opioid overdoses, and suicide-related events in the 6 months post-review. The primary outcome was not statistically significant with a p-value of 0.080. In the population that underwent opioid tapers, the hazard ratios (HR) for suicide-related events and opioid-related SAEs were 6.64 (1.09–40.53, p = 0.05) and 10.43 (0.48–226.80, p = 0.02) respectively when compared to non-tapered patients. The HR for suicide-related events and opioid-related SAEs when opioid therapy was discontinued were 9.95 (2.16–45.94, p = 0.009) and 15.64 (1.09–225.19, p = 0.001) respectively when compared to continuation of opioids. This study showed that data-based opioid risk review may reduce incidence of opioid-related SAEs in patients with chronic pain. Additionally, opioid tapers and discontinuations are significant risk factors for suicide-related events and opioid-related SAEs.

Keywords:

• Pain
• suicide
• death
• risk
• mitigation
• opioid related disorders
• substance use
• opioids

Disclosure statement

This material is the result of work supported with resources and the use of facilities at SAVAHCS and was approved by the SAVAHCS Institutional Review Board and Research and Development Committee. This presentation does not represent the views of the US Department of Veterans Affairs or the United States Government. Authors of this presentation have nothing to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation.

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Funding

The author(s) reported there is no funding associated with the work featured in this article.