Long-term opioid therapy trends in the VA: More intermittent than chronic.

Objective: To observe patterns of opioid therapy among veterans with a focus on long-term opioid therapy (LTOT).

Design: A retrospective study utilizing data from the Veterans Affairs Corporate Data Warehouse.

Subjects: Veterans 18 years or older, who received at least one outpatient opioid prescription between June 1, 2008, and June 1, 2018, and had no cancer, palliative care, or hospice encounters during the study period.

Main measures: For each patient, opioid prescriptions were combined into one contiguous prescription, as long as the gap (<7, <30, <90 days) between the end of supply and the receipt of the next fill met specified intervals. When gaps exceeded the threshold, a new prescription chain began. This was done to explore patterns of opioid fills.

Results: There were 746,658 patients with a prescription gap <7 days who received 5,084,346 contiguous opioid scripts. For all gap lengths, 16-35 percent of contiguous scripts lasted at least 90 days, 3-14 percent lasted more than a year, and 1-8 percent lasted 2 years. While a relatively small proportion of contiguous scripts were long-lasting, a substantial proportion of patients received long-lasting opioid therapy.

Conclusions: Long-term, intermittent opioid therapy was common. However, the long-term, monthly, uninterrupted opioid prescriptions expected with typical LTOT was not. It is likely that LTOT in past research was more reflective of periodic use instead of continuous, monthly prescriptions, especially for multiyear studies.