The Association between Opioid Discontinuation and Heroin Use: A Nested Case-Control Study

Area of Science:

• Public Health
• Epidemiology
• Clinical Pharmacology

Background:

• Opioid prescribing guidelines advise reducing or stopping opioid therapy when treatment harms outweigh benefits.
• As opioid discontinuation increases, understanding its link to heroin use is crucial.
• This study investigated the association between opioid discontinuation and documented heroin use in medical records.

Purpose of the Study:

• To assess the association between opioid discontinuation and subsequent heroin use.
• To quantify the risk of heroin use following the cessation of prescribed opioid therapy.

Main Methods:

• A matched nested case-control study was performed within an integrated health system.
• Patients receiving opioid therapy between January 2006 and June 2018 were analyzed.
• Opioid discontinuation was defined as a gap of at least 45 days without opioid dispensing.

Main Results:

• Of 22,962 patients on opioid therapy, 125 (0.54%) used heroin.
• Patients who used heroin (cases) had approximately double the odds of prior opioid discontinuation compared to controls (mOR = 2.19).
• The odds of opioid discontinuation were significantly higher in patients who initiated heroin use.

Conclusions:

• Opioid discontinuation in patients on chronic opioid therapy is linked to an increased risk of heroin use.
• This elevated risk must be considered alongside the potential benefits when deciding to discontinue opioid treatment.
• Further research is needed to understand the mechanisms driving this association and inform clinical practice.