ArticleJournal of substance use and addiction treatment2025
De-prescribing opioids among Medicaid patients with long-term opioid use.
Article in Journal of substance use and addiction treatment, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundGuidelines encourage deprescribing opioids for long-term opioid patients, especially those using opioids and benzodiazepines, z-drugs, or muscle relaxants ("other respiratory depressants").
objectiveWere long-term opioid patients who were prescribed other respiratory depressants more likely to have deprescribing opioid trajectories?
designCross-sectional retrospective study using pharmacy and professional claims from 2015 to 2019. Adjusted logistic regression models were stratified on low (<50 morphine milligram equivalents; MME) and high (>50 MME) starting opioid doses. We reported predicted probabilities with 95 % confidence intervals. SUBJECTS: Nevada and Colorado Medicaid beneficiaries 18-64 years old without cancer diagnoses with long-term (120 days' supply/6 months) opioid use (117,400 person-windows). MEASURES: We used group-based trajectory modeling in Stata to identify characteristic 12-month dosing trajectories. Using the resulting trajectories, we assigned the outcome = 1 if the observation had a deprescribing trajectory (versus a constant trajectory). Binary exposure variables indicated that the patient had an opioid prescription overlapping with 1, 2, or 3 types of other respiratory depressants.
resultsAmong patients with a low starting opioid dose, the predicted probabilities of a deprescribing trajectory were lower when the patient had overlapping other respiratory depressants compared to when they did not (0 respiratory depressants: 0.33, [0.32, 0.33]; vs. 1 respiratory depressant: 0.22, [0.20, 0.23]; 2 respiratory depressants: 0.18 [0.16, 0.20]; 3 respiratory depressants:0.20 [0.13, 0.27]). Among patients with a high starting opioid dose, we observed similar results. CONCLUSIONS AND RELEVANCE: Targeted provider-level interventions to support deprescribing for long-term opioid patients using opioids and other respiratory depressants may provide particularly high-value care.
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