title: Impact of the Opioid Safety Initiative on opioid-related prescribing in veterans.
abstract: The Veterans Health Administration (VHA) designed the Opioid Safety Initiative (OSI) to help decrease opioid prescribing practices associated with adverse outcomes. Key components included disseminating a dashboard tool that aggregates electronic medical record data to audit real-time opioid-related prescribing and identifying a clinical leader at each facility to implement the tool and promote safer prescribing. This study examines changes associated with OSI implementation in October 2013 among all adult VHA patients who filled outpatient opioid prescriptions. Interrupted time series analyses controlled for baseline trends and examined data from October 2012 to September 2014 to determine the changes after OSI implementation in prescribing of high-dosage opioid regimens (total daily dosages >100 morphine equivalents [MEQ] and >200 MEQ) and concurrent benzodiazepines. Across VHA facilities nationwide, there was a decreasing trend in high-dosage opioid prescribing with 55,722 patients receiving daily opioid dosages >100 MEQ in October 2012, which decreased to 46,780 in September 2014 (16% reduction). The OSI was associated with an additional decrease, compared to pre-OSI trends, of 331 patients per month (95% confidence interval [CI] -378 to -284) receiving opioids >100 MEQ, a decrease of 164 patients per month (95% CI -186 to -142) receiving opioids >200 MEQ, and a decrease of 781 patients per month (95% CI -969 to -593) receiving concurrent benzodiazepines. Implementation of a national health care system-wide initiative was associated with reductions in outpatient prescribing of risky opioid regimens. These findings provide evidence for the potential utility of large-scale interventions to promote safer opioid prescribing.
authors.affiliation: Addiction Center and Mental Health Services, Translations and Outcomes Program, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Lewei A
authors.initials: LA
authors.lastname: Lin
authors.affiliation: Addiction Center and Mental Health Services, Translations and Outcomes Program, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.|Department of Veterans Affairs Healthcare System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA.
authors.forename: Amy S B
authors.initials: ASB
authors.lastname: Bohnert
authors.affiliation: Departments of Psychiatry, Neurology and Psychology, Yale University and Pain Research, Informatics, Multimorbidities and Education (PRIME) Center/11ACSLG, West Haven, CT, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
authors.affiliation: Department of Internal Medicine, Ann Arbor Veterans Affairs Healthcare System and The University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Clay
authors.affiliation: Department of Veterans Affairs Healthcare System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA.
authors.forename: Dara
authors.initials: D
authors.lastname: Ganoczy
authors.affiliation: Addiction Center and Mental Health Services, Translations and Outcomes Program, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.|Department of Veterans Affairs Healthcare System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ilgen
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D055553:Prescription Drugs / Q000009:adverse effects*; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data; D058014:Veterans Health
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs; D001569:Benzodiazepines