This comes from the advance notes of the 2018 National Rx Drug Abuse & Heroin Summit, more of which I’ll post later.
Surprising VA Data About Opioid Discontinuation, Overdose and Suicide: Clinical Implications – Wednesday, April 4, 2018 – Stefan Kertesz, MD, MSc, Professor, University of Alabama at Birmingham, Birmingham VA Medical Center
Despite recommendations within recent guidelines for patient-centered evaluation of the risks and benefits for prescribing opioids for chronic pain, there are concerns regarding the potential iatrogenic effects of initiatives from state regulators, insurers, payers and healthcare organizations that have presented mandates to reduce opioid doses or to discontinue those in patients who currently receive them.
Due to these concerns, the Department of Veterans Affairs (VA) conducted analyses of national data that have found the following:
- In fiscal year 2013, patients prescribed less than 90 morphine equivalent daily dose accounted for 95.8% of the sample and 85.7% of overdose/suicide-related deaths.
- In two sets of fiscal years — 2010-2011 and 2013-2014 — opioid discontinuation was not associated with overdose mortality but was associated with increased suicide mortality.
- In all analyses, patients with mental health or substance use disorders (MH/SUD) accounted for most overdose/suicide-related deaths.
Importantly, the VA studies underscore that efforts to improve patient safety need to take into account that many of the highest risk patients are complex patients with multiple comorbidities, especially MH/SUD conditions.
UPON COMPLETION OF THIS COURSE, PARTICIPANTS WILL BE ABLE TO:
– Recognize that most patients who are prescribed opioids who end up dying from overdose or suicide are below 90 mg morphine equivalent daily dose and have a mental health or substance use disorder.
– Describe how opioid discontinuation was not associated with overdose mortality but was associated with increased suicide mortality in two waves of VA national data.
– Identify strategies for addressing opioid prescribing among complex patients on long-term opioids for chronic pain.
This last phrase is especially significant because it doesn’t phrase “on long-term opioids” as something that has to change.
I’m thrilled that someone HAS been counting pain patient suicides due to discontinuation of opioid pain relief.
I believe this situation will right itself eventually, but even then, it could take a few years to dismantle all the legislation that has imposed arbitrary restrictions.