Category: Federal Forum Posters
Purpose: Testosterone replacement therapy is associated with risks including myocardial infarction, stroke, depression, and aggression. There are several known reversible causes of hypogonadism, one of which is chronic opioid therapy. In March 2016, following a rise in prescription opioid abuse, the CDC released guidelines for prescribing opioids for chronic pain. The VA/DoD followed with their own opioid therapy guidelines in February 2017. The objective of this study is to identify veterans with opioid use as a reversible cause of hypogonadism, determine if a significant opioid dose reduction or discontinuation has occurred, and evaluate whether testosterone therapy was reassessed after that change.
Methods: This multi-site, single center, retrospective cohort study will be submitted to the Institutional Review Board for approval. Patients dispensed testosterone and opioid therapy from March 1, 2016 to February 28, 2018 will be identified and demographics characterized through data warehouse extraction. Only patients filling these medications inside the VA system are to be included. A manual chart review will be conducted to collect the following data: opioid medication, dose, frequency; lab monitoring such as free testosterone, PSA, hematocrit, and A1c; diagnosis of hypogonadism, breast or prostate cancer, myocardial infarction, or osteoporosis; presence of other reversible causes, such as diabetes, obesity, alcohol abuse, marijuana abuse, or end-stage renal disease. We will identify patients initially taking more than 90 mg of morphine equivalents, then conduct chart review to determine if there was a reduction to less than 90 mg morphine equivalents. This patient population will be further evaluated through chart review to see if a follow-up assessment of hypogonadism had been conducted within 12 months of opioid dose reduction or discontinuation.
Results: not applicable
Conclusion: not applicable
Rebekka Burch– PGY1 Pharmacy Resident, VA Tennessee Valley Healthcare System, Nashville, TN