Prevalence and Trends of Concurrent Opioid Analgesic and Benzodiazepine Use Among Veterans Affairs Patients with Post-traumatic Stress Disorder, 2003-2011.
BACKGROUND
Patients with post-traumatic stress disorder (PTSD) have complex and multiple symptoms, including anxiety, insomnia, and co-occurring pain, often treated with opioids and benzodiazepines. While concurrent use of these medications poses safety concerns, little is known about the trends of long-term concurrent use and the prevalence of high-risk conditions among those who are prescribed them. Study objectives were to examine the trends in annual prevalence of long-term concurrent opioid and benzodiazepine use among patients with PTSD and prevalence of high-risk conditions in concurrent users of these medications.


METHODS
Retrospective review of pharmacy records of the Veteran Affairs Northwest Integrated Network (VISN20).


METHODS
Patients (n = 66,210) with PTSD receiving care during 2003-2011.


METHODS
Concurrent use was defined as overlapping opioid and benzodiazepine prescriptions for ≥90 consecutive days. Gender-specific logistic regressions estimated long-term concurrent use of these medications and tested for linear trends over 9-years.


RESULTS
The trend in age-adjusted long-term concurrent opioid and benzodiazepine use over 9-years increased 52.7%, from 3.6% (95% confidence interval, 3.3-3.9%) to 5.5% (5.3-5.8%), in men and 79.5%, from 3.9% (3.0-5.0%) to 7.0% (6.2-7.9%), in women. In 2011, 17.1% of long-term concurrent users were prescribed morphine-equivalent daily doses of opioids ≥100 mg and 49.4% had a documented high-risk condition.


CONCLUSIONS
Despite known risks associated with prescribing opioids and benzodiazepines concurrently, the adjusted prevalence of long-term concurrent use rose significantly among men and women with PTSD in VISN20 over a 9-year period. Common use of these medications among patients with high-risk conditions suggests comprehensive strategies are needed to identify and monitor patients at increased risk for adverse outcomes.
Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, USA.|Center of Excellence in Substance Abuse Treatment and Education, Seattle, USA.|VA Puget Sound Health Care System, Seattle, Washington, USA.|Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.
Eric J
EJ
Hawkins
Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, USA.|Center of Excellence in Substance Abuse Treatment and Education, Seattle, USA.|VA Puget Sound Health Care System, Seattle, Washington, USA.
Carol A
CA
Malte
Center of Excellence in Substance Abuse Treatment and Education, Seattle, USA.
Joel R
JR
Grossbard
Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, USA.|Center of Excellence in Substance Abuse Treatment and Education, Seattle, USA.|VA Puget Sound Health Care System, Seattle, Washington, USA.|Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.
Andrew J
AJ
Saxon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001569:Benzodiazepines / Q000008:administration & dosage*; D004338:Drug Combinations; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D015205:Northwestern United States / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000453:epidemiology; D015995:Prevalence; D012120:Respiration Disorders / Q000453:epidemiology*; D012307:Risk Factors; D017678:Sex Distribution; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data* / Q000639:trends; D014728:Veterans; D055815:Young Adult
D000701:Analgesics, Opioid; D004338:Drug Combinations; D001569:Benzodiazepines
Chronic Pain; High-Risk Conditions; Post-Traumatic Stress Disorder; Trends in Benzodiazepine Use; Trends in Opioid Use