Opioid dosing trends over eight years among US Veterans with musculoskeletal disorders after returning from service in support of recent conflicts

Abstract

Purposes To examine long-term opioid dosing trends among Veterans with chronic pain. Methods We identified 79,015 Veterans with musculoskeletal disorders who were dispensed ≥ 1 opioid prescriptions between 2002–2009 after returning from recent conflicts. Opioid dosing trends were examined using a generalized estimating equation while accounting for patient characteristics, temporal and geographic confounding. Results In total 472,819 opioid prescriptions were dispensed (mean±standard deviation: 6.0±10.1 per Veteran). Both average daily morphine equivalents (ME/d) and the proportion of high-dose prescribing (>100 ME/d) increased from baseline period (2002–2004) to 2006 then remained relatively stable. Veterans with extended-persistent (≥ 40 days over 1–2 episodes) and extended-intermittent (≥ 40 days over ≥ 3 episodes) dispensing patterns received more high-dose prescriptions than those dispensed prescriptions < 40 days, with adjusted Odds Ratios (95% Confidence Interval) of 7.2 (6.0–8.8) and 3.6 (3.0–4.3), respectively. Post-traumatic Stress Disorder and other mental health diagnoses were associated with 30% increased odds of high-dose prescribing. Conclusions The average daily dose of opioid prescriptions and the likelihood of high-dose prescribing to these Veterans appeared to increase from 2002–2006 then remained relatively stable through 2009. Veterans on opioid prescriptions for extended duration or with mental health diagnoses tend to receive higher dose therapy.

Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review

“…Regarding internal validity, all but 1 study[37] clearly defined CNCP, and only 4 studies specified the diagnosis[39,41-43]. All studies clearly defined the presence of PTSD.…”

“…Regarding opioid classes, 3 studies provided a list of specific opioids[41,43,44], 2 studies[42,44] used a standard formula to calculate morphine equivalents to compare opioid doses across classes, and 3 studies[39,43,45] specified opioid replacement therapy for OUD ( i.e ., methadone and buprenorphine) as an exclusion criterion. With regard to opioid intake, 7 studies defined opioid prescription as the outcome variable.…”

“…All but 2 studies[38,39] statistically controlled for demographic characteristics such as age and sex. Three studies also controlled for race/ethnicity[36,37,41]. Of these, 2 also controlled for educational level[37,41] and 2 also controlled for marital status[40,45].…”

“…Musculoskeletal pain was the most common chronic pain condition in the participants: back pain (47.14% across studies; range: 16%-60.6%), arthritis and joint pain (31.1% across studies; range: 18%-67.5%), and neck pain (28.7% across studies, range: 3.6%-63%). Several studies[39,41,43,44] defined chronic pain according to the list of codes provided in the International Statistical Classification of Diseases and Related Health Problems 9 th revision (ICD-9) and 1 study[40] used the 10 th revision (ICD-10). Some of the studies[39,41,42] measured pain intensity, pain interference, and pain disability using self-reports, such as the Numerical Rating Scale(NRS), the Graded Chronic Pain Scale(GCPS)[37], and the Brief Pain Inventory Short Form (BPI-SF)[36].…”

“…In relation to opioid intake, 2 different outcome variables were identified: opioid prescriptions and OUD. Opioid prescriptions were generally assessed according to the medical prescription-dispensing pattern, although this pattern was defined in different ways, such as total number of prescription days[41,42,44,45] and pharmacy records of opioid prescriptions[39,43]. One study[37] only indicated whether or not patients consumed prescribed opioids.…”