title: Clinical monitoring and high-risk conditions among patients with SUD newly prescribed opioids and benzodiazepines.
abstract: BACKGROUND
  Opioid therapy alone or in combination with benzodiazepines poses safety concerns among patients with substance use disorders (SUD). Guidelines for opioid therapy recommend SUD treatment and enhanced monitoring, especially in patients with additional risk factors, but information on monitoring practices is sparse. This study estimated high-risk conditions - psychiatric comorbidity, suicide risk, and age <35 and ≥65 - and described clinical monitoring among patients with SUD who were newly prescribed opioids alone and concurrent with benzodiazepines long-term.
  
  
  METHODS
  This study included VA Northwest Veterans Network patients with SUD who started opioids only (n=980) or benzodiazepines and opioids concurrently (n=353) long-term (≥90 days) in 2009-2010. Clinical characteristics, outpatient visits and urine drug screens (UDS) documented within 7-months after starting medications were extracted from VA data.
  
  
  RESULTS
  Approximately 67% (95% CI: 64-70) of opioids only and 94% (92-97) of concurrent medications groups had ≥1 psychiatric diagnoses. Prevalences of suicide risk and age <35 and ≥65 were 7% (5-8), 6% (5-8) and 18% (15-20) among the opioids only group, and 20% (16-24), 8% (5-11) and 13% (9-16) among the concurrent medications group. Among patients prescribed opioids only and medications concurrently, 87% and 91% attended primary care, whereas 28% and 26% attended SUD specialty-care. Overall, 30% and 48% of opioids only and concurrent medications groups engaged in mental health or SUD care, and 35% and 39% completed UDS.
  
  
  CONCLUSIONS
  Improvements in clinical monitoring are needed as many VA patients with SUD and comorbid risks who initiate opioid therapy do not receive sufficient mental health/SUD care or UDS monitoring.
authors: VA Health Services Research & Development, 1100 Olive Way, Suite 1400, Seattle, WA 98101, United States. Electronic address: joel.grossbard@va.gov.
authors: Joel R
authors: JR
authors: Grossbard
authors: VA Health Services Research & Development, 1100 Olive Way, Suite 1400, Seattle, WA 98101, United States; Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA 98108, United States.
authors: Carol A
authors: CA
authors: Malte
authors: Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA 98108, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, United States.
authors: Andrew J
authors: AJ
authors: Saxon
authors: VA Health Services Research & Development, 1100 Olive Way, Suite 1400, Seattle, WA 98101, United States; Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA 98108, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, United States.
authors: Eric J
authors: EJ
authors: Hawkins
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications / Q000188:drug therapy*; D011320:Primary Health Care; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications*; D014728:Veterans
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines
keywords: Benzodiazepines; Clinical monitoring; Opioid therapy; Substance use disorders; Veterans