Vets with PTSD more likely to receive opioids

HealthDay News -- Iraq and Afghanistan war veterans with mental health diagnoses, particularly post-traumatic stress disorder (PTSD), are more likely to be prescribed opioid medications for pain-related conditions and are at higher risk for opioid-related adverse than those without mental health diagnoses.

Veterans with PTSD were more than three times as likely to receive opioids than those without the diagnosis (RR 2.58, 95% CI 2.49 to 2.67), Karen Seal, MD, MPH, of the VA Medical Center at the University of California San Francisco, and colleagues reported in the Journal of the American Medical Association.

They conducted a retrospective cohort study involving 291,205 veterans who had entered the VA healthcare system between Oct. 1, 2005 and Dec. 31, 2010. A total of 141,029 veterans received at least one non-cancer-related pain diagnosis and 15,676 were prescribed opioids for their pain.

Among veterans with PTSD, 17.8% were prescribed opioids, compared with 11.7% of veterans with other mental health diagnoses -- including depression, anxiety, alcohol use disorders, drug use disorders and traumatic brain injury -- and just 6.5% of veterans without a mental health disorder.

Additionally, those with PTSD who were prescribed opioids were more likely than those with other mental health disorders to:

  • Receive higher dose opioids -- 22.7% vs. 15.9% (adjusted RR=1.42)
  • Recieve two or more opioids concurrently -- 19.8% vs. 10.7% (aRR=1.87)
  • Receive sedative hypnotic concurrently -- 40.7% vs. 7.6% (aRR=5.46
  • Obtain early refills for an opioid prescription -- 33.8% vs. 20.4% (aRR=1.64)

All veterans who received prescription opioids had an increased risk of adverse clinical outcomes, including opioid-related accidents and overdoses, and alcohol and non-opioid-drug-related accidents and overdoses, compared with veterans who did not receive opioid prescriptions (9.5% vs. 4.1%; RR=2.33). This risk was most pronounced in veterans with PTSD.

"Unfortunately, treatment with opioids among patients with mental health problems may result in or exacerbate substance abuse and worsening of mental health symptoms over time," the researchers wrote.

Inappropriate opioid therapy may be the result of health care providers who do not know how to manage these difficult-to-treat patients in any other way, the researchers noted. They called for further efforts to improve care of patients with comorbid pain and PTSD.

Seal KH et al. JAMA. 2012; 307: 940-947.

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