Study Examines Opioid Prescribing for Veterans with Chronic Non-Cancer Pain
Chronic non-cancer pain may occur in up to half of patients treated in primary care settings, including Veterans. Opioids are among the most commonly utilized prescription medications for the treatment of chronic pain, and in the past few decades, the use of opioids for chronic pain has increased dramatically. This retrospective study sought to describe patterns of prescription opioid initiation, identify correlates of opioid initiation, and examine correlates of receipt of chronic opioid therapy (COT) among Veterans with persistent non-cancer pain. Using VA data, investigators identified 5,961 Veterans who received VA healthcare in the Pacific Northwest during calendar year 2008, and who had persistent elevated pain intensity scores but had not been prescribed opioids in the prior 12 months. Veterans who were subsequently prescribed opioids during the 12-month study period were classified into two groups: patients prescribed opioid medications on a short-term basis (<90 days; n=1,797), and patients prescribed opioid medications for 90 or more consecutive days (COT; n=273). Investigators also examined patient demographics, as well as psychiatric and substance use disorders. Veterans prescribed COT were then compared to Veterans who were prescribed opioids for fewer than 90 days (short-term use) and to Veterans who did not receive opioid prescriptions during the study period.
- The initiation of opioid drug therapy is common among Veterans with persistent pain, but most Veterans are not prescribed opioids long-term. During the study year, 35% of Veterans in the sample received an opioid prescription: 30% were prescribed opioids on a short-term basis (<90 days), and 5% received chronic opioid therapy (>90 days).
- Clinical factors associated with initiating COT include increased pain intensity, nicotine dependence, substance use disorders, and major depression diagnoses.
- Nearly one-quarter of Veterans prescribed COT also received prescriptions for benzodiazepine medications, which is a concern given that overdose deaths have been linked to the use of multiple sedating medications.
- Two-thirds of opioid prescriptions resulting in COT were initiated by primary care clinicians. The authors suggest that this supports the development of guidelines geared toward primary care practice. It also supports the provision of interventions and structures in primary care that facilitate proactive planning around opioid use and its monitoring.
- This study relied on the validity and accuracy of administrative data. Further, investigators were not able to evaluate patient adherence to prescribed medications.
- Investigators did not assess the use of non-pharmacological treatments for pain, which may have been associated with opioid prescribing patterns and have clinical implications.
This study was partly supported by HSR&D. Drs. Dobscha and Duckart are part of HSR&D's Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland, OR.
Dobscha S, Morasco B, Duckart J, et al. Correlates of Prescription Opioid Initiation and Long-Term Opioid Use in Veterans with Persistent Pain. The Clinical Journal of Pain February 2013;29(2):102-108.