title: Prevalence and correlates of co-prescribing psychotropic medications with long-term opioid use nationally in the Veterans Health Administration.
abstract: We used national data for fiscal year 2012 to examine demographic, psychiatric and medical diagnoses, indications for psychotropics, and service use correlates of psychotropic medication fills in Veterans with at least 10 opioid prescriptions during the year (the highest 29% of opioid users); and whether the Veteran was treated in a specialty mental health clinic. Of the 328,398 Veterans who filled at least 10 opioid prescriptions, 77% also received psychotropics, of whom: 74% received antidepressants, 55% anxiolytics/sedatives/hypnotics, and 26% three or more classes of psychotropic medications. Altogether, 87% had a psychiatric or medical indication; and 54% received mental health treatment. Veterans treated in a mental health clinic were prescribed more psychotropics and were more likely to have a documented psychiatric or medical indication than those treated solely in other settings. Indicated psychiatric diagnoses were the strongest predictors of specific class of psychotropics prescribed; anxiety disorder and insomnia were most strongly associated with anxioloytics/sedatives/hypnotics receipt. Since psychotropics and opioids can produce harmful side effects, especially when combined, and since they are likely prescribed by separate providers in different settings, coordinated consideration of the risks and benefits of co-prescribing these medications may be needed, along with further study of related adverse events.
authors: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; APT Foundation Pain Treatment Services, New Haven, CT, USA.
authors: Declan T
authors: DT
authors: Barry
authors: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC), West Haven, CT, USA.
authors: Mehmet
authors: M
authors: Sofuoglu
authors: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA.
authors: Robert D
authors: RD
authors: Kerns
authors: VA Connecticut Healthcare System, West Haven, CT, USA; Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA.
authors: Ilse R
authors: IR
authors: Wiechers
authors: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC), West Haven, CT, USA.
authors: Robert A
authors: RA
authors: Rosenheck
mesh_terms: D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000150:complications* / Q000453:epidemiology*; D015995:Prevalence; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000627:therapeutic use*; D007319:Sleep Initiation and Maintenance Disorders; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives; D011619:Psychotropic Drugs
keywords: Opioid; Psychotropic; Veteran