title: Risk factors for opioid overdose and awareness of overdose risk among veterans prescribed chronic opioids for addiction or pain.
abstract: Rising overdose fatalities among U.S. veterans suggest veterans taking prescription opioids may be at risk for overdose. However, it is unclear whether veterans prescribed chronic opioids are aware of this risk. The objective of this study was to identify risk factors and determine awareness of risk for opioid overdose in veterans treated with opioids for chronic pain, using veterans treated with methadone or buprenorphine for opioid use disorder as a high-risk comparator group. In the current study, 90 veterans on chronic opioid medication, for either opioid use disorder or pain management, completed a questionnaire assessing risk factors, knowledge, and self-estimate of risk for overdose. Nearly all veterans in both groups had multiple overdose risk factors, although individuals in the pain management group had on average a significantly lower total number of risk factors than did individuals in the opioid use disorder group (5.9 versus 8.5, p < .0001). On average, participants treated for pain management scored slightly but significantly lower on knowledge of opioid overdose risk factors (12.1 versus 13.5, p < .01). About 70% of participants, regardless of group, believed their overdose risk was below that of the average American adult. There was no significant relationship between self-estimate of overdose risk and either number or knowledge of opioid overdose risk factors. Our results suggest that veterans in both groups underestimated their risk for opioid overdose. Expansion of overdose education to include individuals on chronic opioids for pain management and a shift in educational approaches to overdose prevention may be indicated.
authors.affiliation: a Department of Veterans Affairs Medical Center , Cincinnati , Ohio , USA.|b Department of Psychiatry and Behavioral Neuroscience , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Wilder
authors.affiliation: a Department of Veterans Affairs Medical Center , Cincinnati , Ohio , USA.|b Department of Psychiatry and Behavioral Neuroscience , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA.
authors.forename: Shannon C
authors.initials: SC
authors.lastname: Miller
authors.affiliation: b Department of Psychiatry and Behavioral Neuroscience , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tiffany
authors.affiliation: b Department of Psychiatry and Behavioral Neuroscience , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA.
authors.forename: Theresa
authors.initials: T
authors.lastname: Winhusen
authors.affiliation: c James L. Winkle College of Pharmacy, University of Cincinnati , Cincinnati , Ohio , USA.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Winstanley
authors.affiliation: d Department of Medicine , Alpert School of Medicine of Brown University, Butler Hospital , Providence , Rhode Island , USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stein
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016739:Behavior, Addictive; D002047:Buprenorphine / Q000009:adverse effects; D059350:Chronic Pain / Q000188:drug therapy*; D062787:Drug Overdose / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000009:adverse effects; D008875:Middle Aged; D015146:Midwestern United States; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D059408:Pain Management / Q000009:adverse effects*; D055553:Prescription Drugs / Q000009:adverse effects*; D012307:Risk Factors; D014728:Veterans
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs; D002047:Buprenorphine; D008691:Methadone
keywords: Overdose; chronic pain; medication-assisted treatment; opioids; risk assessment; veterans