title: Increased polysedative use in veterans with posttraumatic stress disorder.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) treatment is often complicated in veterans by co-occurring conditions including pain, insomnia, brain injury, and other mental disorders. Pharmacologic approaches to these conditions can produce an accumulation of sedating medications with potential for safety concerns.
  
  
  OBJECTIVE
  The objective of this study was to characterize polysedative prescribing among veterans with PTSD over an 8-year period.
  
  
  METHODS
  National Department of Veterans Affairs (VA) data were used to identify veterans with PTSD using International Classification of Diseases, Ninth Revision codes among regular medication users. Prescribing of benzodiazepines, hypnotics, atypical antipsychotics, opioids, and muscle relaxants was determined annually. Prevalence and incidence rates were determined for each medication class from 2004 through 2011. Polysedative use was determined from longitudinal refill patterns that indicated concurrent use across sedative classes.
  
  
  RESULTS
  In 2004, 9.8% of veterans with PTSD concurrently received medications from three or more sedative classes. By 2011, the prevalence of concurrent use involving three or more classes increased to 12.1%. Polysedative use varied across demographic subgroups, with higher rates observed among women, rural residents, younger adults, Native Americans and Whites. The most common combination was an opioid plus a benzodiazepine, taken concurrently by 15.9% of veterans with PTSD.
  
  
  CONCLUSIONS
  Important trends in polysedative use among veterans with PTSD illustrate the complexity of treating an intersecting cluster of symptoms managed by sedative medications. As the VA seeks to improve care by focusing on non-pharmacologic options, our findings emphasize the need for a comprehensive approach that encompasses overlapping conditions of relevance to veterans with PTSD.
authors.affiliation: National Center for PTSD, Veterans Affairs Medical Center, White River Junction, VT, USA; Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Bernardy
authors.forename: Brian C
authors.initials: BC
authors.lastname: Lund
authors.forename: Bruce
authors.initials: B
authors.lastname: Alexander
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Friedman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy*; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D006993:Hypnotics and Sedatives
keywords: Clinical Pharmacology; Coordinated Care; Posttraumatic Stress Disorder