Persistent Opioid Use After Combat Injury and Subsequent Long-term Risk of Abuse

Beyer, Carl A.; Poltavskiy, Eduard; Walker, Lauren; Pettey, Warren; Suo, Ying; Redd, Andrew; Rittel, Alex G; Kazanis, William; Dunham, Jacob; Zarzabal, Lee Ann; Rutter, W. Cliff; Sim, Alan; Watrous, Jessica R; Howard, Jeffrey T.; Janak, Jud C.; Stewart, Ian J.; Gundlapalli, Adi V.

doi:10.1097/sla.0000000000003658

Cited by 14 publications

(27 citation statements)

References 37 publications

(104 reference statements)

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“…To our knowledge, only 10 studies have combined data from the DoD and VA data for the purposes of examining veterans' health. [35][36][37][38][39][40][41][42][43][44] While administrative hurdles exist in combining data from two different federal agencies, the primary issue is one of data integration. Different formats and data dictionaries are compounded by the deep institutional knowledge necessary to properly interpret the individual variables in order to ensure a basic minimum level of semantic interoperability.…”

Section: Discussionmentioning

confidence: 99%

The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease

et al. 2020

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Background A better understanding of the long-term health effects of combat injury is important for the management of veterans’ health in the Department of Defense (DoD) and Veterans Affairs (VA) health care systems and may have implications for primary care management of civilian trauma patients. Objective To determine the impact of traumatic injury on the subsequent development of hypertension (HTN), diabetes mellitus (DM), and coronary artery disease (CAD) after adjustment for sociodemographic, health behavior, and mental health factors. Design Retrospective cohort study of current and former US military personnel with data obtained from both the DoD and VA health care systems. Participants Combat injured (n = 8727) service members between 1 February 2002 and 14 June 2016 randomly selected from the DoD Trauma Registry matched 1:1 based on year of birth, sex, and branch of service to subjects that deployed to a combat zone but were not injured. Main Measures Traumatic injury, stratified by severity, compared with no documented injury. Diagnoses of HTN, DM, and CAD defined by International Classification of Diseases 9th or 10th Revision Clinical Modification codes. Key Results After adjustment, severe traumatic injury was significantly associated with HTN (HR 2.78, 95% CI 2.18–3.55), DM (HR 4.45, 95% CI 2.15–9.18), and CAD (HR 4.87, 95% CI 2.11–11.25), compared with no injury. Less severe injury was associated with HTN (HR 1.14, 95% CI 1.05–1.24) and CAD (HR 1.62, 95% CI 1.11–2.37). Conclusions Severe traumatic injury is associated with the subsequent development of HTN, DM, and CAD. These findings have profound implications for the primary care of injured service members in both the DoD/VA health systems and may be applicable to civilian trauma patients as well. Further exploration of pathophysiologic, health behavior, and mental health changes after trauma is warranted to guide future intervention strategies.

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Section: Discussionmentioning

confidence: 99%

The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease

et al. 2020

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“…1 Consequently, reports have emerged over the last decade of high rates of substance abuse disorders among veterans of the Iraq and Afghanistan conflicts, including heightened risks of transition to illegal narcotics, as well as overdosing. [2][3][4][5]25,26 While much of this work has been conducted through the VA health care system, the extent to which deployment-related injuries or combat-related events contribute to the risk of sustained prescription opioid use and the downstream sequelae of misuse, abuse, and consumption of illegal narcotics has not been adequately explored. The fact remains that, because of the nature of combat-related trauma and a heightened risk for the development of other drivers of substance abuse, such as depression or posttraumatic stress, service members with injuries sustained during combat may actually be at a heightened risk of sustained prescription opioid and dependence over the course of treatment for these injuries.…”

Section: Discussionmentioning

confidence: 99%

“…Military rank was classified as either junior enlisted, senior enlisted, or officer based on previously validated approaches that support using military rank as a proxy for socioeconomic status. 4,[13][14][15][16][17][18][19][20] In this paradigm, junior enlisted personnel are considered representative of a lower socioeconomic stratum. Patients were also classified based on opioid exposure before the traumatic injury, depending on whether they had been dispensed opioids within 6 months of the combat-related event.…”

Section: Variable Definitionsmentioning

confidence: 99%

“…2,3 Veterans injured in combat have also previously been cited as being at increased risk of both opioid and sedative misuse. 4,5 The combined military engagements in Afghanistan and Iraq, ongoing since 2001, have produced the largest number of US military casualties since the Vietnam era. [6][7][8] With the evolving nature of warfare in the 21st century and advancements in protective equipment and medical care, more service members are surviving their injuries but are living with long-term sequelae of complex multisystem trauma, including an increased prevalence of blast-related injuries, amputations, and wounds to the head and neck.…”

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confidence: 99%

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Long-term prescription opioid use among US military service members injured in combat

Dalton

Manful

Jarman³

et al. 2021

J Trauma Acute Care Surg

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During the Global War on Terrorism, many US Military service members sustained injuries with potentially long-lasting functional limitations and chronic pain. We sought to understand the patterns of prescription opioid use among service members injured in combat. METHODS:We queried the Military Health System Data Repository to identify service members injured in combat between 2007 and 2011. Sociodemographics, injury characteristics, treatment information, and costs of care were abstracted for all eligible patients. We surveyed for prescription opioid utilization subsequent to hospital discharge and through 2018. Negative binomial regression was used to identify factors associated with cumulative prescription opioid use. RESULTS:We identified 3,981 service members with combat-related injuries presenting during the study period. The median age was 24 years (interquartile range [IQR], 22-29 years), 98.5% were male, and the median follow-up was 3.3 years. During the study period, 98% (n = 3,910) of patients were prescribed opioids at least once and were prescribed opioids for a median of 29 days (IQR, 9-85 days) per patient-year of follow-up. While nearly all patients (96%; n = 3,157) discontinued use within 6 months, 91% (n = 2,882) were prescribed opioids again after initially discontinuing opioids. Following regression analysis, patients with preinjury opioid exposure, more severe injuries, blast injuries, and enlisted rank had higher cumulative opioid use. Patients who discontinued opioids within 6 months had an unadjusted median total health care cost of US $97,800

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“…Substance use disorders, including alcohol use disorder, are prevalent among veterans of recent conflicts and have been associated with up to four times the odds of PTSD and depression (Seal et al., 2011). Opioid abuse (Beyer et al., 2019), chronic pain (Cifu et al., 2013; Higgins et al., 2014; Lee et al., 2019), low‐back pain (Watrous et al., 2020), headache (Jaramillo et al., 2016), and hearing loss (MacGregor et al., 2020) have also been associated with increased likelihood of mental health diagnoses among injured service members. Additionally, injured service members who report poorer sleep and more tobacco use are more likely to screen positive for mental health outcomes (McCabe et al., 2020).…”

Section: Introductionmentioning

confidence: 99%

Longitudinal mental health outcomes of combat‐injured service members

et al. 2021

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Background The relationship between traumatic injury and subsequent mental health diagnoses is not well understood and may have significant implications for patient screening and clinical intervention. We sought to determine the adjusted association between traumatic injury and the subsequent development of post‐traumatic stress disorder (PTSD), depression, and anxiety. Methods Using Department of Defense and Veterans Affairs datasets between February 2002 and June 2016, we conducted a retrospective cohort study of 7,787 combat‐injured United States service members matched 1:1 to combat‐deployed, uninjured service members. The primary exposure was combat injury versus no combat injury. Outcomes were diagnoses of PTSD, depression, and anxiety, defined by International Classification of Diseases 9th and 10th Revision Clinical Modification codes. Results Compared to noninjured service members, injured service members had higher observed incidence rates per 100 person‐years for PTSD (17.1 vs. 5.8), depression (10.4 vs. 5.7), and anxiety (9.1 vs. 4.9). After adjustment, combat‐injured patients were at increased risk of development of PTSD (HR 2.92, 95%CI 2.68–3.17), depression (HR 1.47, 95%CI 1.36–1.58), and anxiety (HR 1.34, 95%CI 1.24–1.45). Conclusions Traumatic injury is associated with subsequent development of PTSD, depression, and anxiety. These findings highlight the importance of increased screening, prevention, and intervention in patients with exposure to physical trauma.

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Persistent Opioid Use After Combat Injury and Subsequent Long-term Risk of Abuse

Abstract: Supplemental Digital Content is available in the text

Cited by 14 publications

References 37 publications

The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease

The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease

Long-term prescription opioid use among US military service members injured in combat

Longitudinal mental health outcomes of combat‐injured service members

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