Study results show that efforts are being made to curb long-term opioid use in the military

Researchers have found “significant reductions” in the use of long-term opioid prescriptions after surgery among patients in the military health system, according to a new report.

A study published Wednesday in the journal Lancet Regional Health found that the risk of long-term prescription opioid use was reduced by 38% among patients undergoing surgery in 2020-2022 compared to 2017-2019.

“This is a really positive story for the health system,” said Dr. Andrew Schoenfeld, who led the study, told Military Times. He is an orthopedic surgeon at Mass General Brigham and a professor at Harvard Medical School.

And lessons learned from the Department of Defense’s specific initiatives, such as the DOD/VA practice guidelines and other approaches related to opioid prescribing, could potentially have greater impact on the civilian sector, the authors noted.

Overall, the rate of long-term prescription opioid use after surgery decreased to 6% of patients in 2020-2022, compared to 11% in 2017-2019. The researchers define “long-term” as continuous, uninterrupted opioid use for six months or longer after surgery. During each of these periods, they examined around 200,000 patients.

Rates in military treatment facilities were significantly better than in private sector care under Tricare.

“This represents an opportunity for further research to better understand the factors associated with greater reductions in long-term prescription opioid use in direct care settings,” the authors said wrote.

Since 2013, there has been a concerted effort across the U.S. health care system to combat the opioid crisis, including efforts to minimize the number and strength of medications dispensed to head off problems that could lead to long-term opioid use. This study is not intended for individuals who received opioid prescriptions or use illicit drugs prior to their surgery.

However, as researchers noted, the impact of the effort has not been adequately measured, and this study addresses one element: reducing long-term opioid prescriptions.

“This study represents one of the largest and most comprehensive longitudinal assessments of opioid use after surgery,” the researchers said in their article. And given the representative nature of the military system’s patients included in the study, “We believe these results reflect national trends and that the approaches developed by the (Military Health System) can effect greater change more broadly when applied to civilian health.” .” system,” they wrote.

These reductions may indicate that health care providers and patients are more familiar with and comfortable with clinical practice guidelines from the Centers for Disease Control and Prevention and the Department of Defense, the authors said.

Researchers at Mass General Brigham in Boston identified people ages 18 to 64 in the Military Health System’s data warehouse who were insured through Tricare and who received one or more prescriptions for an opioid after one of 14 common surgical procedures, such as appendectomies and cataract surgeries Class II or III received, among others. The researchers found that spinal surgery was the most common surgery in both time windows.

They analyzed Tricare claims data for 410,326 surgical events among people who underwent one of 14 common surgical procedures in 2017-2019 and 2020-2022. There were 196,099 operations in 2017-2019 and 214,227 in 2020-2022.

Examining all Military Health System patients who received one of 14 common surgical procedures during this period, They found that the risk of long-term prescription opioid use was “significantly lower” in direct care settings – military treatment facilities – than for Tricare patients in the private sector.

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According to the numbers cited in the article, 6% of patients at military treatment facilities in 2017-2019 experienced long-term use of prescription opioids after surgery; compared to 13% of patients in the private sector, based on Military Times calculations. These are based on the raw numbers and are not adjusted for other factors.

By 2020-2022, long-term opioid use rates among those in military treatment facilities fell to 2.4%, compared to 6.5% among those in private care.

These results are coming than that The military health system is taking steps to move more service members back to military treatment facilities for their treatment, as opposed to private sector care, reversing its years-long effort to move patients to private sector care.

However, the overall results show that regardless of whether care occurs at military treatment facilities or in the private sector, the likelihood of long-term opioid prescriptions in the military health system decreased from 2017 to 2022, Schoenfeld said.

Patients who had undergone previous surgery within six months of an eligible surgical procedure or had an active cancer diagnosis within one year of the surgery date were excluded from the study.