Patterns and Correlates of Prescription Opioid Use in OEF/OIF Veterans with Chronic Noncancer Pain

Abstract

Objectives Little is known about the treatment Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans receive for chronic non-cancer pain (CNCP). We sought to describe the prevalence of prescription opioid use, types and doses of opioids received, and identify correlates of receiving prescription opioids for CNCP among OEF/OIF veterans. Design Retrospective review of VA administrative data. Setting Ambulatory clinics within a VA regional healthcare network. Patients OEF/OIF veterans who had at least 3 elevated pain screening scores within a 12-month period in 2008. Within this group, those prescribed opioids (n=485) over the next 12 months were compared to those not prescribed opioids (n=277). In addition, patients receiving opioids short term (<90 days, n=284) were compared to patients receiving them long-term (≥90 consecutive days, n=201). Results Of 762 OEF/OIF veterans with CNCP, 64% were prescribed at least one opioid medication over the 12 months following their index dates. Of those prescribed an opioid, 59% were prescribed opioids short-term and 41% were prescribed opioids long-term. The average morphine-equivalent opioid dose for short-term users was 23.7 mg (SD=20.5) compared with 40.8 mg (SD=36.1) for long-term users (p<0.001). Fifty-one percent of long-term opioid users were prescribed short-acting opioids only and one-third were also prescribed sedative-hypnotics. In adjusted analyses, diagnoses of low back pain, migraine headache, post-traumatic stress disorder, and nicotine use disorder were associated with an increased likelihood of receiving an opioid prescription. Conclusion Prescription opioid use is common among OEF/OIF veterans with CNCP and is associated with several pain diagnoses and medical conditions.

Correlates of prescription opioid therapy in Veterans with chronic pain and history of substance use disorder

“…Our bivariate finding that participants with SUD prescribed LOT reported greater pain severity than those prescribed NOT or SOT is consistent with our hypothesis and findings from prior studies of patients with chronic pain [8,20]. Unfortunately, we do not have data documenting participant pain ratings prior to the initiation of opioid therapy to determine whether pain severity reduced as a result of LOT.…”

“…It is thus unclear what adjunctive services participants may have been using concurrently with, or as alternatives to, opioids to manage pain. Finally, sample size limitations may have contributed to our failure to obtain statistically significant findings for variables previously shown to be associated with opioid therapy (e.g., PTSD and active SUD diagnoses) [8,20].…”

“…To identify correlates of prescription opioid therapy, we categorized participants into three groups: (1) no opioid therapy (NOT) in the past 90 d (n = 134), (2) SOT (<90 d duration; n = 31), or (3) LOT (90 d duration; n = 49). Similar definitions of SOT and LOT have been used in prior studies [8,20,[41][42].…”

“…These include younger age, male sex, white race, mental health diagnoses (e.g., depressive disorders and posttraumatic stress disorder [PTSD]), specific pain diagnoses (e.g., low back pain, neck or joint pain, arthritis), and greater perceived pain intensity [8][9][19][20]. Notably, Veterans with comorbid chronic pain and SUD, relative to Veterans with chronic pain and no SUD, are also more likely to be prescribed SOT and LOT at high doses [2,8,13,[21][22].…”

Point Prevalence of Co-Occurring Behavioral Health Conditions and Associated Chronic Disease Burden Among Adolescents

“…However, this methodology has been used in prior studies, and we do not anticipate it to be an issue. [39][40][41][42][43] Finally, patients with Medicare or Medicaid were not included in the study, as these populations are known to have higher rates of BHCs, and we wished to prevent bias between patients with versus without BHCs.…”