Research News

HSR&D Research Helps VA Reduce Opioid Risk and Develop Suicide Prevention Strategies

December 20, 2017

In 2017, VA health services researchers published 64 journal articles examining the burden of suicide and risky opioid use among Veterans – and testing strategies to address these dual VA priorities. Findings from these research studies have helped shape VA programs including the Opioid Safety Initiative, the Recovery Engagement and Coordination for Health – Veterans Enhanced Treatment (VA REACH-VET) program, as well as other elements of VA’s suicide prevention strategy.  Among the important findings in 2017 from these studies are:

• Fewer Veterans are receiving high doses of opioids or concomitant interacting medicines such as benzodiazepines, and more Veterans are receiving non-opioid pain therapies, naloxone, and treatment for substance use disorders. (Gellad W, et al., 2017)
• Veterans who use both VA and Medicare pharmacies to fill opioid prescriptions are three times as likely to be taking unsafe levels of opioids. (Suda K, et al., 2017)
• Among Veterans who discontinue long-term opioids, the decision to do so is initiated by clinicians 85% of the time, usually (75% of the time) because patients have exhibited aberrant behaviors associated with opioids. (Lovejoy T, et al., 2017)
• Approximately 23% of all OEF/OIF Veterans received opioid medications, usually moderate doses for short periods (median 30-40 days).  The strongest risk factor for chronic use of opioids was back pain. (Hudson T, et al., 2017)
• A systematic review of 67 studies found several types of interventions have been shown to be effective for reducing dose among long-term opioid users, and studies suggested reductions resulted in improved pain, function, and quality of life. (Frank J, et al., 2017)
• An analysis of 13 years of data across all VHA inpatient mental health units reported 141 reports of suicide within 7 days of discharge, and a large proportion (43%, n = 61) followed an unplanned discharge. Flaws in the design and execution of processes of care as well as deficits in communication may contribute to post-discharge suicide. Inpatient teams should be aware of the potentially heightened risk for suicide among patients with unplanned discharges. (Riblet N, et al., 2017)
• Among 509 Veterans whose clinicians discontinued opioids, 9% had suicidal ideation and 2% suicidal self-directed violence. (Demidenko M, et al., 2017)
• A comprehensive review of suicide prevention among Veteran and military populations found 6 of 8 population-level interventions lowered suicide rates. (Nelson H, et al., 2017)