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This study aimed to measure the association between discontinuing COT and diagnoses of substance use disorders (SUDs) and opioid\u2010related adverse outcomes (AOs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>United States Veterans Healthcare Administration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Veterans with chronic pain on COT who discontinued opioid therapy were compared with those continuing COT using data from fiscal years 2009 to 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Newly diagnosed substance use disorders (SUD composite; individual types: opioid, non\u2010opioid drug and alcohol use disorders) and opioid\u2010related adverse outcomes (AO composite; individual types: accidents resulting in wounds\/injuries, opioid\u2010related accidents\/overdoses, alcohol and non\u2010opioid medication\u2010related accidents\/overdoses, self\u2010inflicted injuries and violence\u2010related injuries) were evaluated. Primary analyses were conducted using 1:1 matching of discontinuers with those continuing COT based on propensity score and index date (\u00b1180\u2010day window). Sensitivity analyses were conducted using logistic regressions with stabilized inverse probability of treatment weighting (SIPTW) and instrumental variable (IV) models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>A total of 15\u2009695 (75.4%) and 17\u2009337 (76.6%) discontinuers were matched with those continuing COT among the cohorts testing SUD and AO development respectively. In the primary propensity score matched analyses, the composite SUD outcome was not different between discontinuers and those continuing COT (OR\u2009=\u20090.932, 95% CI = 0.850, 1.022). The composite AO outcome was lower among discontinuers (OR\u2009=\u20090.660, 95% CI = 0.623, 0.699) compared with those continuing COT. SIPTW analyses found lower SUD (OR\u2009=\u20090.789, 95% CI = 0.743, 0.837), and AO (OR\u2009=\u20090.660, 95% CI = 0.623, 0.699) rates among discontinuers. IV models found mixed and sometimes contradictory results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Discontinuing patients from chronic opioid therapy appears to be associated with decreased diagnoses for opioid\u2010related adverse outcomes. The association with substance use disorders appears to be inconclusive.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.15689","type":"journal-article","created":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T08:06:24Z","timestamp":1631520384000},"page":"946-968","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Association between discontinuing chronic opioid therapy and newly diagnosed substance use disorders, accidents, self\u2010inflicted injuries and drug overdoses within the prescribers' health care system: a retrospective cohort study"],"prefix":"10.1111","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7776-6157","authenticated-orcid":false,"given":"Corey J.","family":"Hayes","sequence":"first","affiliation":[{"name":"Division of Health Services Research, College of Medicine University of Arkansas for Medical Sciences  Little Rock AR USA"},{"name":"Center for Mental Healthcare and Outcomes Research Central Arkansas Veterans Healthcare System  Little Rock AR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0843-7410","authenticated-orcid":false,"given":"Erin E.","family":"Krebs","sequence":"additional","affiliation":[{"name":"Center for Care Delivery and Outcomes Research Minneapolis VA Healthcare System  Minneapolis MN USA"},{"name":"Department of Medicine University of Minnesota Medical School  Minneapolis MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2778-5149","authenticated-orcid":false,"given":"Chenghui","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Pharmaceutical Evaluation and Policy, College of Pharmacy University of Arkansas for Medical Sciences  Little Rock AR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2973-1021","authenticated-orcid":false,"given":"Joshua","family":"Brown","sequence":"additional","affiliation":[{"name":"Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida  Gainesville FL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6672-6774","authenticated-orcid":false,"given":"Teresa","family":"Hudson","sequence":"additional","affiliation":[{"name":"Division of Health Services Research, College of Medicine University of Arkansas for Medical Sciences  Little Rock AR USA"},{"name":"Center for Mental Healthcare and Outcomes Research Central Arkansas Veterans Healthcare System  Little Rock AR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8402-3098","authenticated-orcid":false,"given":"Bradley C.","family":"Martin","sequence":"additional","affiliation":[{"name":"Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida  Gainesville FL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,10,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","unstructured":"DowellD HaegerichTM ChouR.CDC Guideline for Prescribing Opioids for Chronic Pain \u2014 United States 2016. 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