Opioid Use among Afghanistan and Iraq War Veterans
BACKGROUND:
Over the last two decades, prescribing opioid medications to treat chronic pain has increased dramatically, along with an increase in opioid abuse/dependence and accidental overdose, suggesting increases in use and abuse may be linked. Moreover, there has been a great deal of concern about opioid use among Veterans, particularly those who served in Afghanistan (OEF) and Iraq (OIF and OND). Therefore, this study sought to fully understand the pharmacoepidemiology of current opioid use in OEF/OIF/OND Veterans who are regular users of VA care and did not have a cancer diagnosis at the time of this study. Investigators identified all OEF/OIF/OND Veterans that used inpatient or outpatient VA care from FY09 to FY12. Investigators also examined patient demographics, medication, and clinical characteristics, including five common areas of pain among Veterans: neck, back, arthritis/joint, headache/migraine, and neuropathic. Mental health and substance use disorders also were assessed, in addition to pain severity. Opioid use was categorized as chronic (>90 days/year) or non-chronic (<90 days/year); it was further categorized by evaluating the proportion of chronic users who received a daily dose of >100mg Morphine Equivalent Dose (MED) and those who received >120mg MED, since opioid doses at these levels have been identified as high-dose and related to overdose.
FINDINGS:
- Opioid use among OEF/OIF/OND Veterans is characterized by moderate doses that are used over relatively long periods of time by a minority of Veterans. Approximately 23% of all OEF/OIF/OND Veterans received opioids, with 7-8% receiving them chronically.
- The mean MED was approximately 26mg daily, across all study years. Among chronic users, the dose was higher, but still moderate at about 35mg MED daily in each year.
- The prevalence of high-dose opioids, concurrent use of multiple opioids, and use of long-acting opioids was fairly low. For example, 4% of chronic users (approximately 1.5% of all opioid users) received MED >120mg daily.
- Diagnoses of PTSD, major depressive disorder, and tobacco use disorder were strongly associated with chronic opioid use. Back pain also was strongly associated with chronic use.
IMPLICATIONS:
- Study findings suggest that the use of opioids is less common among OEF/OIF/OND Veterans compared with Veterans as a whole, and provide a strong baseline for evaluating the impact of recently implemented additional opioid-related policies.
LIMITATIONS:
- This study did not include opioids that Veterans may have received outside VA.
- It is possible that some diagnoses were miscoded or that some Veterans had a particular diagnosis that was not annotated in the medical record.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D. Drs. Hudson and Painter are part of HSR&D's Center for Mental Healthcare and Outcomes Research (CeMHOR), North Little Rock, AR.
Hudson T, Painter J, Martin B, et al. Pharmacoepidemiologic Analyses of Opioid Use among OEF/OIF/OND Veterans. Pain. March 25, 2017; Epub ahead of print.
