A patient sitting in a hospital room, looking distressed, with a doctor’s desk in the background showing scattered papers and a computer. The atmosphere is tense, representing the uncertainty after opioid treatment discontinuation. A focus on the patient’s anxiety and the emotional weight of opioid withdrawal.
Long-term opioid treatment (LTOT) is a common approach to managing chronic pain, particularly among older adults. However, this study sheds light on the often-overlooked consequences of discontinuing LTOT when a patient’s prescriber exits the workforce. Researchers focused on how this disruption affects both opioid use and broader health outcomes.
One of the key aspects of the research was the use of a difference-in-differences methodology. By comparing patients whose prescribers left the workforce with those who retained theirs, the study was able to uncover notable differences in health outcomes.
Dr. Adrienne Sabety, one of the lead researchers, explains: “We observed a marked increase in discontinuation rates following prescriber exit, with 229 per 10,000 patients discontinuing opioid treatment in the quarter after the exit, compared to just 100 in the control group.”
Short-Term Health Risks: Suicide Attempts and Mental Health Crises
The study reported a significant uptick in adverse events immediately after prescriber exit. Dr. Hannah Neprash elaborates: “In the first quarter post-exit, we saw a spike in suicide attempts and hospital admissions related to mental health crises. This was a transient effect, but the short-term risks were clear.”
These adverse effects receded after one to two quarters, indicating that the most vulnerable period for patients is immediately after the disruption in care. However, while these mental health issues surged, the study did not find a corresponding rise in drug overdose rates.
Opioid Discontinuation and Withdrawal
One of the central findings of the research was the increase in opioid discontinuation. Patients whose prescribers exited the workforce were more likely to stop receiving opioid prescriptions, which often led to withdrawal symptoms.
Dr. Marema Gaye notes: “We found a significant increase in opioid or alcohol withdrawal incidents, as well as related hospitalizations. Patients in this group faced immediate challenges adjusting to the loss of their long-term treatment.”
The loss of a prescriber may push patients to abruptly stop using opioids, resulting in withdrawal symptoms that could exacerbate underlying health conditions.
The Broader Impact on Health Care Systems
The study also looked at the broader implications of LTOT discontinuation for healthcare systems. As opioid prescriptions decreased, other areas of the healthcare system, including emergency departments and mental health services, saw increased pressure.
Dr. Michael Barnett summarizes: “Our findings highlight the unintended consequences of prescriber workforce exits. While there is a push to reduce opioid prescriptions, it’s important to understand that patients in long-term treatment require careful management, particularly when their primary care providers leave the workforce.”
The research suggests that policymakers and healthcare providers need to be more vigilant about how prescriber exits are managed to mitigate the associated risks. Ensuring continuity of care during prescriber transitions could play a critical role in preventing adverse health outcomes.
Citation:
Sabety AH, Neprash HT, Gaye M, Barnett ML. Clinical and healthcare use outcomes after cessation of long term opioid treatment due to prescriber workforce exit: quasi-experimental difference-in-differences study. BMJ. 2024;385. doi:10.1136/bmj-2023-076509
License:
This content is generated from the original article original article and it’s under Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
