ID: HR19-1477

Presenting author: Phillip Coffin

Presenting author biography:

Phillip Coffin is a board-certified and practicing internist, infectious disease, and addiction medicine specialist, and Director of Substance Use Research at the San Francisco’s health department. He runs clinical trials and observational studies addressing pharmacotherapies and behavioral interventions for use disorders and medical sequelae of methamphetamine, alcohol, cocaine, and opioids

Impacts of changing opioid prescribing policy in the United States

Phillip Coffin, Christopher Rowe, Emily Behar, Milo Santos, Eric Vittinghoff

BACKGROUND: The reliance of the U.S. medical system on opioids for management of pain is believed to have led to the prescription opioid epidemic and to have set the stage for the subsequent crisis with synthetic opioids. Responses to this crisis have largely focused on reducing prescribing of opioids, yet guidelines to-date have not distinguished between opioid-naïve and opioid-experienced patients.
METHODS: We describe the conduct and preliminary results of four studies examining the impact of changing opioid prescribing policies and practices. These include a retrospective chart review, retrospective cohort, prospective cohort, and qualitative study of patients who have been prescribed long-term opioids for management of chronic pain.
RESULTS: We have completed enrollment in all studies and chart abstractions are currently underway. Results to-date are consistent with a deep division between patient and provider experience with regard to the need for opioids, the process of tapering or discontinuing opioids, and the impact on engagement in medical care. Preliminary comparison of patient self-report of illicit opioid use and opioid prescription records suggest that discontinuation of opioid prescriptions is associated with subsequent increases in the frequency of illicit opioid use.
CONCLUSION: Patients who are opioid-experienced represent a distinct population to be addressed in the response to the U.S. opioid crisis.