Majority of OEF/OIF Veterans with Chronic Non-Cancer Pain are Prescribed Opioids by VA Outpatient Providers
BACKGROUND:
Over the past 20 years, chronic non-cancer pain (CNCP) has increasingly been managed with opioid medications, but the safety and efficacy of long-term opioid therapy for CNCP is unclear. Pain is highly prevalent among returning OEF/OIF Veterans, who have higher rates of complex injuries including polytrauma. Polytrauma and blast-related injuries have been shown to increase the prevalence of pain conditions, such as chronic low back pain and head pain. However, little is known about the treatment OEF/OIF Veterans receive for CNCP. This retrospective study sought to describe the prevalence of prescription opioid use, types and doses of opioids received, as well as factors associated with the prescription of opioids among OEF/OIF Veterans. Using VA administrative data, investigators identified 762 OEF/OIF Veterans who had at least three elevated pain screening scores during 2008 (Veterans are routinely screened for pain in clinical settings as part of VA’s “Pain as the Fifth Vital Sign” campaign), and who had received treatment at any VA facility in the Pacific Northwest (VISN 20). They also identified the proportion of Veterans who had received prescriptions for opioids (n=485) and those who had not (n=284) over the next 12 months. In addition, investigators examined patient demographics, history of mental health disorders (including substance use disorders), and opioid dosage and duration data.
FINDINGS:
- About two-thirds of OEF/OIF Veterans with chronic non-cancer pain were prescribed opioids over a one-year timeframe.
- Of Veterans prescribed any opioids, 59% were prescribed opioids ‘short-term’ compared to 41% prescribed opioids ‘long-term’ (more than 90 days). The mean duration of opioid prescription was 61 days for Veterans in the short-term group and 285 days for Veterans in the long-term group.
- Several findings suggest a need for improvement in adherence to pain and opioid treatment guidelines. For example, among long-term opioid users, 51% were prescribed short-acting opioids only (guidelines recommend transitioning to long-acting opioids); only 31% were administered one or more urine drug screens (guidelines suggest more frequent drug screening); and 33% were also prescribed sedative-hypnotic medications (monitoring by prescribing physicians is recommended to prevent possible overdose or death).
- Diagnoses associated with an increased likelihood of receiving an opioid prescription included: low back pain, migraine headache, PTSD, and nicotine use disorder.
LIMITATIONS:
- This study relied on administrative data. Because prescription medication information was obtained from administrative data, patient adherence cannot be confirmed.
- Veterans who participated in this study received VA care in the Pacific Northwest only.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D. Drs. Macey, Duckart and Dobscha are part of HSR&D’s Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders.
Macey T, Morasco B, Duckart J, and Dobscha S. Patterns and Correlates of Prescription Opioid Use in OEF/OIF Veterans with Chronic Non-Cancer Pain. Pain Medicine September 7, 2011;e-pub ahead of print.
