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Data-Based Opioid Risk Review in Patients with Chronic Pain: A Retrospective Chart Review
Joshua Pogue1, Lily Lau1, Jeffrey Boyer1
1Southern Arizona VA Healthcare System, Tucson, Arizona, USA.
Journal of Pain & Palliative Care Pharmacotherapy
|November 29, 2023
Summary
Data-based opioid risk review may reduce serious adverse events (SAEs) and overdoses. However, opioid tapers and discontinuations significantly increase risks for suicide-related events and SAEs.
Area of Science:
- Pharmacology
- Public Health
- Clinical Medicine
Background:
- Opioid-associated serious adverse events (SAEs) pose a significant public health challenge.
- Effective risk mitigation strategies are crucial for managing chronic pain patients on opioid therapy.
Purpose of the Study:
- To evaluate the impact of data-based opioid risk review on reducing opioid-associated SAEs.
- To compare SAE rates 6 months before and after implementing the risk review process.
Main Methods:
- Retrospective cohort chart review at a single center.
- Analysis of opioid-associated SAEs, including suicide-related events and overdoses.
- Multivariate logistic regression and McNemar's test for statistical comparison.
Main Results:
- The primary outcome of composite reduction in opioid-related SAEs was not statistically significant (p=0.080).
- Opioid tapers were associated with significantly higher hazard ratios (HR) for suicide-related events (6.64, p=0.05) and SAEs (10.43, p=0.02).
- Opioid discontinuation showed even higher HRs for suicide-related events (9.95, p=0.009) and SAEs (15.64, p=0.001).
Conclusions:
- Data-based opioid risk review may decrease the incidence of opioid-related SAEs in chronic pain patients.
- Opioid tapers and discontinuations are identified as significant risk factors for suicide-related events and SAEs.
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