Effect of a Veterans Health Administration mandate to case review patients with opioid prescriptions on mortality among patients with opioid use disorder: a secondary analysis of the STORM randomized control trial

Aims The Veterans Health Administration (VHA) implemented the Stratification Tool for Opioid Risk Mitigation (STORM) to reduce the risk of serious adverse events (SAE) among patients with opioid analgesic prescriptions. VHA facilities were mandated to case review patients identified as high risk by...

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Veröffentlicht in:Addiction (Abingdon, England) England), 2023-05, Vol.118 (5), p.870-879
Hauptverfasser: Auty, Samantha G., Barr, Kyle D., Frakt, Austin B., Garrido, Melissa M., Strombotne, Kiersten L.
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container_end_page 879
container_issue 5
container_start_page 870
container_title Addiction (Abingdon, England)
container_volume 118
creator Auty, Samantha G.
Barr, Kyle D.
Frakt, Austin B.
Garrido, Melissa M.
Strombotne, Kiersten L.
description Aims The Veterans Health Administration (VHA) implemented the Stratification Tool for Opioid Risk Mitigation (STORM) to reduce the risk of serious adverse events (SAE) among patients with opioid analgesic prescriptions. VHA facilities were mandated to case review patients identified as high risk by STORM. The aim of this study was to measure the effect of this mandate on all‐cause mortality and SAEs among VHA patients newly diagnosed with opioid use disorder (OUD). Design Secondary analysis of a stepped‐wedged cluster randomized controlled trial conducted at all 140 VHA facilities, with facility as the unit of randomization, from 2018 to 2020. Setting and Participants United States VHA facilities were randomized to case review the top 1 or 5% of high‐risk patients prescribed opioid analgesics identified by STORM. A total of 28 251 patients were diagnosed with OUD during the trial and were considered control or treatment depending on the status of the facility where they received their OUD diagnosis. Post‐hoc analyses among patients who had at least one opioid analgesic prescription in the 90 days prior to diagnosis were conducted and were then stratified by receipt of a prescription in the 90 days following diagnosis to assess the sensitivity of results to opioid discontinuation. Measurements All‐cause mortality and opioid‐related, drug‐related, suicide‐related and other SAEs within 90 days of OUD diagnosis. Findings Mandated case review increased the odds of 90‐day mortality [odds ratio (OR) = 1.74, 95% confidence interval (CI) = 1.06, 2.87], but did not significantly change the odds of SAEs. Among patients who received an opioid prescription prior to but not after OUD diagnosis, the odds of all‐cause mortality within 90 days was 5.87 (95% CI = 1.85, 18.58) relative to control patients. Conclusions Veterans Health Administration patients newly diagnosed with opioid use disorder experienced increased all‐cause mortality following expansion of a case review mandate for high‐risk patients prescribed opioids.
doi_str_mv 10.1111/add.16110
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VHA facilities were mandated to case review patients identified as high risk by STORM. The aim of this study was to measure the effect of this mandate on all‐cause mortality and SAEs among VHA patients newly diagnosed with opioid use disorder (OUD). Design Secondary analysis of a stepped‐wedged cluster randomized controlled trial conducted at all 140 VHA facilities, with facility as the unit of randomization, from 2018 to 2020. Setting and Participants United States VHA facilities were randomized to case review the top 1 or 5% of high‐risk patients prescribed opioid analgesics identified by STORM. A total of 28 251 patients were diagnosed with OUD during the trial and were considered control or treatment depending on the status of the facility where they received their OUD diagnosis. Post‐hoc analyses among patients who had at least one opioid analgesic prescription in the 90 days prior to diagnosis were conducted and were then stratified by receipt of a prescription in the 90 days following diagnosis to assess the sensitivity of results to opioid discontinuation. Measurements All‐cause mortality and opioid‐related, drug‐related, suicide‐related and other SAEs within 90 days of OUD diagnosis. Findings Mandated case review increased the odds of 90‐day mortality [odds ratio (OR) = 1.74, 95% confidence interval (CI) = 1.06, 2.87], but did not significantly change the odds of SAEs. Among patients who received an opioid prescription prior to but not after OUD diagnosis, the odds of all‐cause mortality within 90 days was 5.87 (95% CI = 1.85, 18.58) relative to control patients. Conclusions Veterans Health Administration patients newly diagnosed with opioid use disorder experienced increased all‐cause mortality following expansion of a case review mandate for high‐risk patients prescribed opioids.</description><identifier>ISSN: 0965-2140</identifier><identifier>EISSN: 1360-0443</identifier><identifier>DOI: 10.1111/add.16110</identifier><identifier>PMID: 36495477</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Analgesics ; Analgesics, Opioid - therapeutic use ; Clinical trials ; Critical incidents ; Diagnosis ; Discontinued ; Drug abuse ; Drug addiction ; High risk ; Hospital administration ; Humans ; Management ; Medical diagnosis ; Military hospitals ; Mitigation ; Mortality ; Narcotics ; Newly diagnosed ; opioid ; opioid discontinuation ; opioid use disorder ; Opioid-Related Disorders ; Opioids ; Prescription drugs ; Prescriptions ; randomized control trial ; Risk reduction ; Stratification ; Substance use disorder ; Suicidal behavior ; Suicide ; United States ; United States Department of Veterans Affairs ; Veterans ; Veterans Health</subject><ispartof>Addiction (Abingdon, England), 2023-05, Vol.118 (5), p.870-879</ispartof><rights>2023 Society for the Study of Addiction.</rights><rights>2023 Society for the Study of Addiction</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3530-ae801e659166f1eb0ec1f9e3063ad972111f37bc794b930cb1556f6aabdece963</citedby><cites>FETCH-LOGICAL-c3530-ae801e659166f1eb0ec1f9e3063ad972111f37bc794b930cb1556f6aabdece963</cites><orcidid>0000-0002-0776-4025 ; 0000-0002-7457-7211</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fadd.16110$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fadd.16110$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36495477$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Auty, Samantha G.</creatorcontrib><creatorcontrib>Barr, Kyle D.</creatorcontrib><creatorcontrib>Frakt, Austin B.</creatorcontrib><creatorcontrib>Garrido, Melissa M.</creatorcontrib><creatorcontrib>Strombotne, Kiersten L.</creatorcontrib><title>Effect of a Veterans Health Administration mandate to case review patients with opioid prescriptions on mortality among patients with opioid use disorder: a secondary analysis of the STORM randomized control trial</title><title>Addiction (Abingdon, England)</title><addtitle>Addiction</addtitle><description>Aims The Veterans Health Administration (VHA) implemented the Stratification Tool for Opioid Risk Mitigation (STORM) to reduce the risk of serious adverse events (SAE) among patients with opioid analgesic prescriptions. VHA facilities were mandated to case review patients identified as high risk by STORM. The aim of this study was to measure the effect of this mandate on all‐cause mortality and SAEs among VHA patients newly diagnosed with opioid use disorder (OUD). Design Secondary analysis of a stepped‐wedged cluster randomized controlled trial conducted at all 140 VHA facilities, with facility as the unit of randomization, from 2018 to 2020. Setting and Participants United States VHA facilities were randomized to case review the top 1 or 5% of high‐risk patients prescribed opioid analgesics identified by STORM. A total of 28 251 patients were diagnosed with OUD during the trial and were considered control or treatment depending on the status of the facility where they received their OUD diagnosis. Post‐hoc analyses among patients who had at least one opioid analgesic prescription in the 90 days prior to diagnosis were conducted and were then stratified by receipt of a prescription in the 90 days following diagnosis to assess the sensitivity of results to opioid discontinuation. Measurements All‐cause mortality and opioid‐related, drug‐related, suicide‐related and other SAEs within 90 days of OUD diagnosis. Findings Mandated case review increased the odds of 90‐day mortality [odds ratio (OR) = 1.74, 95% confidence interval (CI) = 1.06, 2.87], but did not significantly change the odds of SAEs. Among patients who received an opioid prescription prior to but not after OUD diagnosis, the odds of all‐cause mortality within 90 days was 5.87 (95% CI = 1.85, 18.58) relative to control patients. 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Barr, Kyle D. ; Frakt, Austin B. ; Garrido, Melissa M. ; Strombotne, Kiersten L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3530-ae801e659166f1eb0ec1f9e3063ad972111f37bc794b930cb1556f6aabdece963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Analgesics</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Clinical trials</topic><topic>Critical incidents</topic><topic>Diagnosis</topic><topic>Discontinued</topic><topic>Drug abuse</topic><topic>Drug addiction</topic><topic>High risk</topic><topic>Hospital administration</topic><topic>Humans</topic><topic>Management</topic><topic>Medical diagnosis</topic><topic>Military hospitals</topic><topic>Mitigation</topic><topic>Mortality</topic><topic>Narcotics</topic><topic>Newly diagnosed</topic><topic>opioid</topic><topic>opioid discontinuation</topic><topic>opioid use disorder</topic><topic>Opioid-Related Disorders</topic><topic>Opioids</topic><topic>Prescription drugs</topic><topic>Prescriptions</topic><topic>randomized control trial</topic><topic>Risk reduction</topic><topic>Stratification</topic><topic>Substance use disorder</topic><topic>Suicidal behavior</topic><topic>Suicide</topic><topic>United States</topic><topic>United States Department of Veterans Affairs</topic><topic>Veterans</topic><topic>Veterans Health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Auty, Samantha G.</creatorcontrib><creatorcontrib>Barr, Kyle D.</creatorcontrib><creatorcontrib>Frakt, Austin B.</creatorcontrib><creatorcontrib>Garrido, Melissa M.</creatorcontrib><creatorcontrib>Strombotne, Kiersten L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Animal Behavior Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Addiction (Abingdon, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Auty, Samantha G.</au><au>Barr, Kyle D.</au><au>Frakt, Austin B.</au><au>Garrido, Melissa M.</au><au>Strombotne, Kiersten L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of a Veterans Health Administration mandate to case review patients with opioid prescriptions on mortality among patients with opioid use disorder: a secondary analysis of the STORM randomized control trial</atitle><jtitle>Addiction (Abingdon, England)</jtitle><addtitle>Addiction</addtitle><date>2023-05</date><risdate>2023</risdate><volume>118</volume><issue>5</issue><spage>870</spage><epage>879</epage><pages>870-879</pages><issn>0965-2140</issn><eissn>1360-0443</eissn><abstract>Aims The Veterans Health Administration (VHA) implemented the Stratification Tool for Opioid Risk Mitigation (STORM) to reduce the risk of serious adverse events (SAE) among patients with opioid analgesic prescriptions. VHA facilities were mandated to case review patients identified as high risk by STORM. The aim of this study was to measure the effect of this mandate on all‐cause mortality and SAEs among VHA patients newly diagnosed with opioid use disorder (OUD). Design Secondary analysis of a stepped‐wedged cluster randomized controlled trial conducted at all 140 VHA facilities, with facility as the unit of randomization, from 2018 to 2020. Setting and Participants United States VHA facilities were randomized to case review the top 1 or 5% of high‐risk patients prescribed opioid analgesics identified by STORM. A total of 28 251 patients were diagnosed with OUD during the trial and were considered control or treatment depending on the status of the facility where they received their OUD diagnosis. Post‐hoc analyses among patients who had at least one opioid analgesic prescription in the 90 days prior to diagnosis were conducted and were then stratified by receipt of a prescription in the 90 days following diagnosis to assess the sensitivity of results to opioid discontinuation. Measurements All‐cause mortality and opioid‐related, drug‐related, suicide‐related and other SAEs within 90 days of OUD diagnosis. Findings Mandated case review increased the odds of 90‐day mortality [odds ratio (OR) = 1.74, 95% confidence interval (CI) = 1.06, 2.87], but did not significantly change the odds of SAEs. Among patients who received an opioid prescription prior to but not after OUD diagnosis, the odds of all‐cause mortality within 90 days was 5.87 (95% CI = 1.85, 18.58) relative to control patients. Conclusions Veterans Health Administration patients newly diagnosed with opioid use disorder experienced increased all‐cause mortality following expansion of a case review mandate for high‐risk patients prescribed opioids.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>36495477</pmid><doi>10.1111/add.16110</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-0776-4025</orcidid><orcidid>https://orcid.org/0000-0002-7457-7211</orcidid></addata></record>
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ispartof Addiction (Abingdon, England), 2023-05, Vol.118 (5), p.870-879
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1360-0443
language eng
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source MEDLINE; Wiley Journals
subjects Analgesics
Analgesics, Opioid - therapeutic use
Clinical trials
Critical incidents
Diagnosis
Discontinued
Drug abuse
Drug addiction
High risk
Hospital administration
Humans
Management
Medical diagnosis
Military hospitals
Mitigation
Mortality
Narcotics
Newly diagnosed
opioid
opioid discontinuation
opioid use disorder
Opioid-Related Disorders
Opioids
Prescription drugs
Prescriptions
randomized control trial
Risk reduction
Stratification
Substance use disorder
Suicidal behavior
Suicide
United States
United States Department of Veterans Affairs
Veterans
Veterans Health
title Effect of a Veterans Health Administration mandate to case review patients with opioid prescriptions on mortality among patients with opioid use disorder: a secondary analysis of the STORM randomized control trial
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