(182) - Pain care utilization following episodes of specialty substance use disorder treatment

Abstract

Substance use disorders (SUDs) are common in patients with chronic non-cancer pain and associated with poor pain treatment engagement and clinical outcomes. Unfortunately, patients with active SUDs are often difficult to engage in care. Specialty SUD treatment programs may be optimally positioned to concomitantly treat active SUDs and help patients engage in needed pharmacologic and non-pharmacologic pain care. We utilized retrospective VA administrative data to identify a cohort of all U.S. Department of Veterans Affairs (VA) patients with chronic non-cancer pain and a SUD between 2010 and 2013. A total of 126,390 patients met study inclusion criteria. 18,964 of these patients subsequently received a full episode of SUD treatment, while an additional 63,939 received some specialty SUD treatment without completing a full treatment episode. Generalized estimating equations controlled for key demographic and clinical variables and compared 12-month pain care utilization between patients with specialty SUD treatment engagement to those with no specialty SUD treatment. Relative to patients who received no specialty SUD treatment, those who received incomplete episodes of SUD treatment were more likely to be prescribed Non-opioid Pharmacotherapy (OR = 1.05 [95% CI = 1.02–1.08]), and engage in Occupational Therapy (OR = 1.47 [1.40–1.53]), while less likely to be prescribed Opioid Pharmacotherapy (OR = .92[.88–.96]) or Primary Care encounters (OR = .98[.97–.99]). Patients who completed full episodes of SUD treatment, compared to patients who received no SUD treatment, were more likely to be prescribed Non-opioid Pharmacotherapy (OR = 1.72[1.66–1.79]) and receive Rehabilitation Medicine (OR = 1 .75[1.63–1.89]), Occupational Therapy (OR = 5.60[528-5.94]), Specialty Pain Clinic (OR = 1.20[1.11–1.30]), and Primary Care treatment (OR = 1.57[1.53–1.60]), while less likely to be prescribed Opioid Pharmacotherapy (OR = .82[.79–.85]). For patients with comorbid chronic non-cancer pain and active SUDs, episodes of specialty SUD treatment may present an optimal time for delivering needed pain care to this hard-to-reach population. Supported by grant IK2HX001516 from VA Health Services Research & Development.