The influence of propoxyphene withdrawal on opioid use in veterans

Corey J. Hayes, Teresa J. Hudson, Martha M. Phillips, Zoran Bursac, James S. Williams, Mark A. Austin, Mark J. Edlund, Bradley C. Martin

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Purpose: Our aim is to determine if propoxyphene withdrawal from the US market was associated with opioid continuation, continued chronic opioid use, and secondary propoxyphene-related adverse events (emergency department visits, opioid-related events, and acetaminophen toxicity). Methods: Medical service use and pharmacy data from 19/11/08 to 19/11/11 were collected from the national Veterans Healthcare Administration healthcare databases. A quasi-experimental pre-post retrospective cohort design utilizing a historical comparison group provided the study framework. Logistic regression controlling for baseline covariates was used to estimate the effect of propoxyphene withdrawal. Results: There were 24328 subjects (policy affected n=10747; comparison n=13581) meeting inclusion criteria. In the policy-affected cohort, 10.6% of users ceased using opioids, and 26.6% stopped chronic opioid use compared with 3.8% and 13.5% in the historical comparison cohort, respectively. Those in the policy-affected cohort were 2.7 (95%CI: 2.5-2.8) and 3.2 (95%CI: 2.9-3.6) times more likely than those in the historical comparison cohort to discontinue chronic opioid and any opioid use, respectively. Changes in adverse events and Emergency Department (ED) visits were not different between policy-affected and historical comparison cohorts (p>0.05). Conclusions: The withdrawal of propoxyphene-containing products resulted in rapid and virtually complete elimination in propoxyphene prescribing in the veterans population; however, nearly 90% of regular users of propoxyphene switched to an alternate opioid, and three quarters continued to use opioids chronically.

Original languageEnglish (US)
Pages (from-to)1180-1188
Number of pages9
JournalPharmacoepidemiology and Drug Safety
Volume24
Issue number11
DOIs
StatePublished - Nov 1 2015

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Dextropropoxyphene
Veterans
Opioid Analgesics
Hospital Emergency Service
Product Recalls and Withdrawals
Delivery of Health Care
United States Department of Veterans Affairs
Pharmaceutical Services
Acetaminophen
Logistic Models
Databases

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Pharmacology (medical)

Cite this

Hayes, C. J., Hudson, T. J., Phillips, M. M., Bursac, Z., Williams, J. S., Austin, M. A., ... Martin, B. C. (2015). The influence of propoxyphene withdrawal on opioid use in veterans. Pharmacoepidemiology and Drug Safety, 24(11), 1180-1188. https://doi.org/10.1002/pds.3851

The influence of propoxyphene withdrawal on opioid use in veterans. / Hayes, Corey J.; Hudson, Teresa J.; Phillips, Martha M.; Bursac, Zoran; Williams, James S.; Austin, Mark A.; Edlund, Mark J.; Martin, Bradley C.

In: Pharmacoepidemiology and Drug Safety, Vol. 24, No. 11, 01.11.2015, p. 1180-1188.

Research output: Contribution to journalArticle

Hayes, CJ, Hudson, TJ, Phillips, MM, Bursac, Z, Williams, JS, Austin, MA, Edlund, MJ & Martin, BC 2015, 'The influence of propoxyphene withdrawal on opioid use in veterans', Pharmacoepidemiology and Drug Safety, vol. 24, no. 11, pp. 1180-1188. https://doi.org/10.1002/pds.3851
Hayes CJ, Hudson TJ, Phillips MM, Bursac Z, Williams JS, Austin MA et al. The influence of propoxyphene withdrawal on opioid use in veterans. Pharmacoepidemiology and Drug Safety. 2015 Nov 1;24(11):1180-1188. https://doi.org/10.1002/pds.3851
Hayes, Corey J. ; Hudson, Teresa J. ; Phillips, Martha M. ; Bursac, Zoran ; Williams, James S. ; Austin, Mark A. ; Edlund, Mark J. ; Martin, Bradley C. / The influence of propoxyphene withdrawal on opioid use in veterans. In: Pharmacoepidemiology and Drug Safety. 2015 ; Vol. 24, No. 11. pp. 1180-1188.
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abstract = "Purpose: Our aim is to determine if propoxyphene withdrawal from the US market was associated with opioid continuation, continued chronic opioid use, and secondary propoxyphene-related adverse events (emergency department visits, opioid-related events, and acetaminophen toxicity). Methods: Medical service use and pharmacy data from 19/11/08 to 19/11/11 were collected from the national Veterans Healthcare Administration healthcare databases. A quasi-experimental pre-post retrospective cohort design utilizing a historical comparison group provided the study framework. Logistic regression controlling for baseline covariates was used to estimate the effect of propoxyphene withdrawal. Results: There were 24328 subjects (policy affected n=10747; comparison n=13581) meeting inclusion criteria. In the policy-affected cohort, 10.6{\%} of users ceased using opioids, and 26.6{\%} stopped chronic opioid use compared with 3.8{\%} and 13.5{\%} in the historical comparison cohort, respectively. Those in the policy-affected cohort were 2.7 (95{\%}CI: 2.5-2.8) and 3.2 (95{\%}CI: 2.9-3.6) times more likely than those in the historical comparison cohort to discontinue chronic opioid and any opioid use, respectively. Changes in adverse events and Emergency Department (ED) visits were not different between policy-affected and historical comparison cohorts (p>0.05). Conclusions: The withdrawal of propoxyphene-containing products resulted in rapid and virtually complete elimination in propoxyphene prescribing in the veterans population; however, nearly 90{\%} of regular users of propoxyphene switched to an alternate opioid, and three quarters continued to use opioids chronically.",
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