OEF/OIF/OND Veterans that Currently Smoke More Likely to Receive Opioid Prescription than Non-Smokers
BACKGROUND:
OEF/OIF/OND Veterans smoke at twice the rate of similarly-aged US civilian adults (40% vs 19%). Cigarette smoking rates are higher among individuals with mental health diagnoses, such as anxiety, depression, PTSD, and substance use disorders, which also are highly prevalent among Veterans receiving VA healthcare. Further, clinically significant pain is reported by more than one-third of OEF/OIF/OND Veterans, and smoking status has been shown to be associated with pain in this cohort. This study sought to determine if smoking status is associated with the receipt of opioids among OEF/OIF/OND Veterans – and to examine important covariates of smoking (i.e., current pain intensity, gender, and mental health diagnoses) and receipt of opioids. Using VA and DoD data, investigators identified 406,954 OEF/OIF/OND Veterans (including 50,988 women) who had at least one visit to a VA primary care clinic between 2001 and 2012. Based on a 0-10 point scale, current pain intensity was rated by patients during primary care screening as no pain/mild (0-3) to moderate/severe (4-10). The receipt of opioids was defined as at least one prescription fill +/-30 days of smoking status assessment. [Buprenorphine and Methadone were excluded as the majority of their use is to treat opioid use disorder.] Demographics, body mass index, and military characteristics also were assessed.
FINDINGS:
- Compared to non-smokers, OEF/OIF/OND Veterans who were current smokers were more likely to receive an opioid prescription, even after controlling for covariates including: pain intensity, age, gender, service-connection, substance use disorder, mood disorders, and anxiety disorders. Veterans who reported a higher current pain intensity and those with pain diagnoses also were more likely to receive an opioid prescription.
- Among this young cohort of Veterans (mean age=30 years), more than one-third (34%) reported moderate to severe current pain intensity within +/-30 days of smoking status, with approximately 8% (n=32,994) receiving at least one opioid prescription.
- Overall, 37% and 16% of Veterans were current or former smokers, respectively.
IMPLICATIONS:
- Smoking status should be an essential consideration when evaluating OEF/OIF/OND Veterans with pain and opioid use. Clinical implications suggest targeting smoking cessation in the context of pain and opioid use, and offering non-pharmacologic therapies for treating chronic pain.
LIMITATIONS:
- Investigators relied on self-reported measures of smoking, and they used a one-item measure of current pain intensity.
- This study did not answer the question of whether smoking leads to an increase in opioid use or opioid use results in continued smoking among Veterans with pain.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 12-118). Dr. Bastian and co-authors are part of HSR&D's Pain Research, Informatics, Multimorbidities, and Education Center (PRIME) in West Haven, CT.
Bastian L, Driscoll M, Heapy A, et al. Cigarette Smoking Status and Receipt of an Opioid Prescription among Veterans of Recent Wars. Pain Medicine. September 21, 2016;e-pub ahead of print.
