title: The 1-Year Treatment Course of New Opioid Recipients in Veterans Health Administration.
abstract: BACKGROUND
  Understanding opioid prescribing trends requires differentiating clinically distinct short- and long-term receipt patterns.
  
  
  OBJECTIVE
  Describe the one-year course of opioid receipt among new opioid recipients and determine the proportion with subsequent long-term opioid therapy. Discern variation in proportion with long-term therapy initiation by geographic region and across Veterans Health Administration (VHA) medical centers.
  
  
  METHODS
  Longitudinal course of opioid receipt was analyzed using a cabinet supply approach. Short-term receipt was defined as index treatment episode lasting no longer than 30 days; long-term therapy as treatment episode of >90 days that began within the first 30 days following opioid index date.
  
  
  METHODS
  All VHA pharmacy users in 2004 and to 2011 who received a new prescription for an opioid (incident opioid recipients) preceded by 365 days with no opioid prescribed.
  
  
  RESULTS
  The proportion of all incident recipients who met the definition for long-term therapy within the first year decreased from 20.4% (N = 76,280) in 2004 to 18.3% (N = 96,166) in 2011. The proportion of incident recipients with chronic pain was unchanged between 2004 and 2011. Hydrocodone and tramadol increased as a proportion of initial opioids prescribed. Median days initially supplied decreased from 30 to 20 days. A greater percentage of new opioid prescriptions were for 7 days or fewer (20.9% in 2004; 27.9% in 2011). The proportion of new recipients who initiated long-term opioid therapy varied widely by medical center. Medical centers with higher proportions of new long-term recipients in 2004 saw greater decreases in this metric by 2011.
  
  
  CONCLUSIONS
  The proportion of new opioid recipients who initiated long-term opioid therapy declined between 2004 and 2011.
authors.affiliation: *Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Health Care System, Iowa City, Iowa.|The Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, Iowa.
authors.forename: Hilary J
authors.initials: HJ
authors.lastname: Mosher
authors.affiliation: *Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Health Care System, Iowa City, Iowa.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Richardson
authors.affiliation: *Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Health Care System, Iowa City, Iowa.|Department of Epidemiology, University of Iowa, College of Public Health, Iowa City, Iowa, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Lund
keywords: Chronic Non-Cancer Pain; Incidence; Opioids; Prevalence; Veterans