The article, “Impact of Mandated Case Review Policy on Opioid Discontinuation and Mortality Among High-Risk Long-Term Opioid Therapy Patients: The STORM Stepped-Wedge Cluster Randomized Controlled Trial,” has been published in SAj.
In this commentary, the authors state that the United States is facing a severe opioid crisis. Opioid overdose deaths rose from 47 600 in 2017 to 80 411 in 2021 and are the leading cause of injury deaths in the U.S. Veterans are at a greater risk of overdose-related adverse events due to higher rates of chronic pain, mental health disorders, and substance use disorders relative to the general U.S. population.
In the AUTHORS’ OWN WORDS, they relate the importance of their work:
“Given the observed mortality benefits of the mandated case review policy and the potential challenges posed to LTOT patients who are discontinued from opioids, it is possible that the mandated case review policy could help clinicians consider unique factors such as duration of treatment, type of pain, and the physical and psychological attributes of the patient, and tailor their practice to cater for individual patient’s needs and concerns. Providers may change their prescribing patterns to ensure safe and effective opioid use for the patients, which could result in reduced mortality risk. Our study aimed to evaluate the impact of the mandated case review policy on discontinuation of VHA opioid prescriptions. We further tested the effect of the mandated case review policy on mortality among the subset of high-risk patients receiving LTOT. We hypothesized that the mandated case review policy would reduce the risk of prescription opioid discontinuation and mortality for LTOT patients.”
“This is the first national study suggesting that a predictive model-targeted prevention program had an impact on reducing likelihood of discontinuation for high-risk patients receiving LTOT. The findings also show a substantial decrease in the risk of mortality resulting from the mandated case review policy for this group of patients. Further investigation of interventions that maintain care engagement while optimizing pain management for high-risk patients may be beneficial for minimizing mortality and other risks.”