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Factors Associated with Opioid Initiation in OEF/OIF/OND Veterans with Traumatic Brain Injury.

Hudson TJ, Painter JT, Gressler LE, Lu L, Williams JS, Booth BM, Martin BC, Sullivan MD, Edlund MJ. Factors Associated with Opioid Initiation in OEF/OIF/OND Veterans with Traumatic Brain Injury. Pain medicine (Malden, Mass.). 2018 Apr 1; 19(4):774-787.

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Objective: These analyses examined opioid initiation and chronic use among Iraq (OIF) and Afghanistan (OEF/OND) veterans with a new diagnosis of traumatic brain injury (TBI) in the Veterans Health Administration (VHA). Methods: Data were obtained from national VHA data repositories. Analyses included OEF/OIF/OND veterans with a new TBI diagnosis in 2010-2012 who used the VHA at least twice, had not received a VHA opioid prescription in the 365?days before diagnosis, and had at least 365?days of data available after TBI diagnosis. Results: Analyses included 35,621 veterans. Twenty-one percent initiated opioids; among new initiators, 23% used chronically. The mean dose was 24.0?mg morphine equivalent dose (MED) daily (SD? = 24.26); mean days supplied was 60.52 (SD? = 74.69). Initiation was significantly associated with age 36-45?years (odds ratio [OR]? = 1.09, 95% CI? = 1.01-1.17, P? = 0.04), female gender (OR? = 1.22, P? < 0.001), having back pain (OR? = 1.38, P? < 0.0001), arthritis/joint pain (OR? = 1.24, P? < 0.0001), or neuropathic pain (OR? = 1.415, P? < 0.02). In veterans age 36-45?years, those living in small rural areas had higher odds of chronic opioid use (OR? = 1.31, P? < 0.0001, and OR? = 1.33, P? = 0.006, respectively) and back pain (OR? = 1.36, P? = 0.003). Headache/migraine pain was associated with decreased odds of chronic opioid use (OR? = 0.639, P? = 0.003). Conclusions: Prevalence of opioid use is relatively low among OEF/OIF/OND veterans with newly diagnosed TBI who are using VHA. Among those who initiated opioids, about 25% use them chronically. Prescribing was mostly limited to moderate doses, with most veterans using opioids for approximately two months of the 12-month study period.

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