title: The influence of propoxyphene withdrawal on opioid use in veterans.
abstract: OBJECTIVE
  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 24,328 subjects (policy affected n = 10,747; comparison n = 13,581) 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.
authors.affiliation: Department of Pharmacy, Baptist Health Medical Center -Little Rock, AR, USA.|Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Corey J
authors.initials: CJ
authors.lastname: Hayes
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.|Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.
authors.forename: Teresa J
authors.initials: TJ
authors.lastname: Hudson
authors.affiliation: College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Martha M
authors.initials: MM
authors.lastname: Phillips
authors.affiliation: Division of Biostatistics and Center for Population Sciences, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Bursac
authors.affiliation: Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Williams
authors.affiliation: Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Austin
authors.affiliation: Behavioral Health Epidemiology Program, RTI International, NC, USA.|Behavioral Health Services, St. Luke's Health System, Twin Falls, ID, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Edlund
authors.affiliation: Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.|Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Martin
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D016208:Databases, Factual; D011431:Dextropropoxyphene / Q000008:administration & dosage* / Q000009:adverse effects; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D056737:Safety-Based Drug Withdrawals; D014481:United States; D014728:Veterans; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000082:Acetaminophen; D011431:Dextropropoxyphene
keywords: opioid discontinuation; pharmacoepidemiology; propoxyphene withdrawal