{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T06:28:05Z","timestamp":1782368885478,"version":"3.54.5"},"reference-count":41,"publisher":"BMJ","license":[{"start":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T00:00:00Z","timestamp":1715817600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2024,3,13]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the association between prescriber workforce exit, long term opioid treatment discontinuation, and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Quasi-experimental difference-in-differences study<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>20% sample of US Medicare beneficiaries, 2011-18.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>People receiving long term opioid treatment whose prescriber stopped providing office based patient care or exited the workforce, as in the case of retirement or death (n=48\u2009079), and people whose prescriber did not exit the workforce (n=48\u2009079).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcomes<\/jats:title>\n                    <jats:p>Discontinuation from long term opioid treatment, drug overdose, mental health crises, admissions to hospital or emergency department visits, and death. Long term opioid treatment was defined as at least 60 days of opioids per quarter for four consecutive quarters, attributed to the plurality opioid prescriber. A difference-in-differences analysis was used to compare individuals who received long term opioid treatment and who had a prescriber leave the workforce to propensity-matched patients on long term opioid treatment who did not lose a prescriber, before and after prescriber exit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Discontinuation of long term opioid treatment increased from 132 to 229 per 10\u2009000 patients who had prescriber exit from the quarter before to the quarter after exit, compared with 97 to 100 for patients who had a continuation of prescriber (adjusted difference 1.22 percentage points, 95% confidence interval 1.02 to 1.42). In the first quarter after provider exit, when discontinuation rates were highest, a transient but significant elevation was noted between the two groups of patients in suicide attempts (adjusted difference 0.05 percentage points (95% confidence interval 0.01 to 0.09)), opioid or alcohol withdrawal (0.14 (0.01 to 0.27)), and admissions to hospital or emergency department visits (0.04 visits (0.01 to 0.06)). These differences receded after one to two quarters. No significant change in rates of overdose was noted. Across all four quarters after prescriber exit, an increase was reported in the rate of mental health crises (0.39 percentage points (95% confidence interval 0.08 to 0.69)) and opioid or alcohol withdrawal (0.31 (0.014 to 0.58)), but no change was seen for drug overdose (\u22120.12 (\u22120.41 to 0.18)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The loss of a prescriber was associated with increased occurrences of discontinuation of long term opioid treatment and transient increases in adverse outcomes, such as suicide attempts, but not other outcomes, such as overdoses. Long term opioid treatment discontinuation may be associated with a temporary period of adverse health impacts after accounting for unobserved confounding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2023-076509","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T06:35:16Z","timestamp":1715841316000},"page":"e076509","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Clinical and healthcare use outcomes after cessation of long term opioid treatment due to prescriber workforce exit: quasi-experimental difference-in-differences study"],"prefix":"10.1136","volume":"385","author":[{"given":"Adrienne H","family":"Sabety","sequence":"first","affiliation":[{"name":"Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah T","family":"Neprash","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marema","family":"Gaye","sequence":"additional","affiliation":[{"name":"Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4884-6609","authenticated-orcid":false,"given":"Michael L","family":"Barnett","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Harvard T H Chan School of Public Health and Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,5,16]]},"reference":[{"key":"2025110102291775000_385.may16_5.e076509.1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6736a2"},{"key":"2025110102291775000_385.may16_5.e076509.2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00783"},{"key":"2025110102291775000_385.may16_5.e076509.3","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-020-06402-z"},{"key":"2025110102291775000_385.may16_5.e076509.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k2833"},{"key":"2025110102291775000_385.may16_5.e076509.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2015.10.002"},{"key":"2025110102291775000_385.may16_5.e076509.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1914257"},{"key":"2025110102291775000_385.may16_5.e076509.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.11013"},{"key":"2025110102291775000_385.may16_5.e076509.8","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.16271"},{"key":"2025110102291775000_385.may16_5.e076509.9","doi-asserted-by":"crossref","unstructured":"Dowell D Haegerich TM Chou R . 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