Better quality of care may reduce the risk of death for patients who are prescribed opioid painkillers for chronic pain, according to new research.
The new study, from researchers at Yale University, encourages physicians to connect these patients with mental health services and substance abuse treatment. It also advises avoiding co-prescriptions for sedatives.
The researchers note that medical societies such as the American Pain Society and the American Academy of Pain Medicine have developed guidelines for treating patients prescribed opioid painkillers, such as Oxycontin and Vicodin, for 90 days or more.
However, physicians frequently do not follow these recommendations, in part because there has been little evidence to support their use, the Yale scientists note.
Guidelines include recommendations related to patient monitoring, including follow-up visits; testing; and multi-disciplinary care, such as mental health services, substance abuse treatment, and physical rehabilitation.
To investigate the impact of “guideline-concordant” care — care that adheres to the guidelines — the researchers reviewed and analyzed the records of more than 17,000 Veterans Affairs patients treated with long-term opioid therapy for pain.
These patients initiated opioid therapy between 2000 and 2010, and outcomes were assessed one year later.
The researchers found that after one year, more than 1,000 — or six percent — of patients had died, but that guideline-concordant care had an impact.
“Those who received mental health services, substance abuse treatment, and physical rehabilitation were less likely to die within the first six months of starting opioids,” said Dr. Julie R. Gaither, a postdoctoral fellow at Yale School of Medicine and the study’s first author. “Patients who received mental health care were 50 percent less likely to die.”
However, patients who received benzodiazepines, or sedatives, in addition to opioids were approximately 1.5 times more likely to die, while patients who did not receive treatment for substance abuse were 2.5 times more likely to die, according to the study’s findings.
The researchers added they found no difference in mortality for patients who received recommended follow-up visits or urine drug testing.
“Opioids are addictive, and patients who have substance use disorder are at great risk,” said Gaither. “Physicians should manage these patients with addiction specialists and mental heath providers.”
She also stressed that care needs to be taken with prescribing sedatives in combination with opioids because of the potential for adverse events.
“Patients who receive care that is closer to what is recommended by the guidelines do better and are less likely to die,” Gaither concluded.
The study was published in the Journal of General Internal Medicine.