Opioid Use Patterns Among Active Duty Service Members and Civilians: 2006–2014

Kazanis, William; Pugh, Mary Jo; Tami, Claudina; Maddry, Joseph K.; Bebarta, Vikhyat S.; Finley, Erin P.; McGeary, Don; Carnahan, David Hobart; Potter, Jennifer Sharpe

doi:10.1093/milmed/usx014

Cited by 23 publications

(17 citation statements)

References 12 publications

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“…Previous studies have demonstrated inflection points [6; 9; 16] with opioid prescribing, albeit at different times. Kazanis et al, [6] for example, using time-series forecasting models with both military and civilian data showed increasing and then decreasing prescriptions for opioids (inflection point about 2011) [6]. We did not find a decrease in the 2011-2013 period as they did.…”

Section: Opioid and Non-opioid Analgesicscontrasting

confidence: 51%

Analgesic prescribing trends in a national sample of older veterans with osteoarthritis: 2012-2017

Trentalange

Runels

Bean

et al. 2019

Pain

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Few investigations examine patterns of opioid and nonopioid analgesic prescribing and concurrent pain intensity ratings before and after institution of safer prescribing programs such as the October 2013 Veterans Health Administration system-wide Opioid Safety Initiative (OSI) implementation. We conducted a quasi-experimental pre–post observational study of all older U.S. veterans (≥50 years old) with osteoarthritis of the knee or hip. All associated outpatient analgesic prescriptions and outpatient pain intensity ratings from January 1, 2012 to December 31, 2016, were analyzed with segmented regression of interrupted time series. Standardized monthly rates for each analgesic class (total, opioid, nonsteroidal anti-inflammatory drug, acetaminophen, and other study analgesics) were analyzed with segmented negative binomial regression models with overall slope, step, and slope change. Similarly, segmented linear regression was used to analyze pain intensity ratings and percentage of those reporting pain. All models were additionally adjusted for age, sex, and race. Before OSI implementation, total analgesic prescriptions showed a steady rise, abruptly decreasing to a flat trajectory after OSI implementation. This trend was primarily due to a decrease in opioid prescribing after OSI. Total prescribing after OSI implementation was partially compensated by continuing increased prescribing of other study analgesics as well as a significant rise in acetaminophen prescriptions (post-OSI). No changes in nonsteroidal anti-inflammatory drug prescribing were seen. A small rise in the percentage of those reporting pain but not mean pain intensity ratings continued over the study period with no changes associated with OSI. Changes in analgesic prescribing trends were not paralleled by changes in reported pain intensity for older veterans with osteoarthritis.

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Section: Opioid and Non-opioid Analgesicscontrasting

confidence: 51%

Analgesic prescribing trends in a national sample of older veterans with osteoarthritis: 2012-2017

Trentalange

Runels

Bean

et al. 2019

Pain

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“…Since 2012, both the Department of Defense and VHA have initiated prescription guidelines to limit long‐term medication pain management, and there is initial evidence based on analysis of VHA administrative data that these measures are reducing long‐term opiate prescription use in VHA . However, opioid misuse among veterans and the rates of substance use disorders (SUDs) remain high, suggesting the need for other measures to address this problem …”

Section: Purposementioning

confidence: 99%

“…A recent review of the epidemiology of SUDs in US veterans found widely varying estimates based on type of data (administrative vs direct diagnostic assessment) and whether or not the sample targeted both treated and untreated SUD . There are a range of community‐based studies of both treated and untreated SUD that determine veteran status based on self‐report . These studies can help inform VHA about veteran SUD and treatment in the community and complement prevalence and treatment estimates based on VHA administrative data.…”

Section: Purposementioning

confidence: 99%

“…6 There are a range of community-based studies of both treated and untreated SUD that determine veteran status based on self-report. 7,11,17,[19][20][21][22][23][24] These studies can help inform VHA about veteran SUD and treatment in the community and complement prevalence and treatment estimates based on VHA administrative data. They can also identify potential resources to promote overall access to care for veterans with SUDs.…”

mentioning

confidence: 98%

“…[12][13][14][15] However, opioid misuse among veterans and the rates of substance use disorders (SUDs) remain high, suggesting the need for other measures to address this problem. 6,10,[16][17][18] It is a challenge for VHA to develop a comprehensive understanding of the trends in SUDs for veterans, including opioid use disorders, because not all veterans are enrolled in VHA. Even those who are enrolled may go untreated or may choose to seek care outside VHA.…”

mentioning

confidence: 99%

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Community Treatment for Opioid Use Disorders in Urban and Rural Veterans

Turvey

Lund

Jones

et al. 2019

The Journal of Rural Health

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Purpose The recent opioid crisis is characterized by a relatively greater increase in opioid use disorder and related mortality in rural populations when compared with urban populations.1‐5 As almost a quarter of our nation's veterans reside in rural settings, the United States Veterans Health Administration (VHA) is interested in the impact of this epidemic on rural veterans. This study aims to develop a comprehensive understanding of the trends in substance use disorders (SUD) in veterans seeking treatment from community, non‐VHA providers. Methods Using Substance Abuse and Mental Health Services Administration (SAMHSA)’s Treatment Episode Data Set (TEDS), this study presents the prevalence of treatment for veterans seeking initial admission into publicly funded non‐VHA SUD treatment centers for years 2011‐2016. Comparisons were made for all SUD types. Multivariate trend analysis based on annual data from 2011 to 2016 compared urban and rural veterans for opioid use disorder treatment. Findings Both urban and rural veterans had comparable rates of treatment for SUD, though rural veterans had slightly higher rates of injectable (11.2% vs 8.7%; P < .001) and opiate drug use disorder admissions (20.7% vs 18.1%; P = .014). Both urban and rural showed an increase in admissions for opioid, heroin, and injectable drug use disorders between 2011 and 2016 (P < .001). Conclusions Comprehensive understanding of veteran SUD and treatment should include national‐level data on community non‐VHA treatment. SAMHSA's TEDS for years 2011‐2016 provides clinical information for more than 90,000 veterans and indicates continued increase in treatment seeking for opioid use disorders, particularly for rural veterans.

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