title: Cigarette Smoking Status and Receipt of an Opioid Prescription Among Veterans of Recent Wars.
abstract: Cigarette smokers seeking treatment for chronic pain have higher rates of opioid use than nonsmokers. This study aims to examine whether veterans of Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) who smoke are more likely to receive an opioid prescription than nonsmokers, adjusting for current pain intensity.
  
  
  
  Cross-sectional analysis of a cohort study of OEF/OIF/OND veterans who had at least one visit to a Veterans Health Administration primary care clinic between 2001 and 2012.
  
  
  
  Smoking status was defined as current, former, and never. Current pain intensity (+/- 30 days of smoking status), based on the 0-10 numeric rating scale, was categorized as no pain/mild (0-3) and moderate/severe (4-10). Opioid receipt was defined as at least one prescription filled +/- 30 days of smoking status.
  
  
  
  We identified 406,954 OEF/OIF/OND veterans: The mean age was 30 years, 12.5% were women (n = 50,988), 66.3% reported no pain or mild pain intensity, 33.7% reported moderate or severe pain intensity, 37.2% were current smokers, and 16% were former smokers. Overall, 33,960 (8.3%) veterans received one or more opioid prescription. Current smoking (odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.52-1.61) and former smoking (OR = 1.27, 95% CI = 1.22-1.32) were associated with a higher likelihood of receipt of an opioid prescription compared with never smoking, after controlling for other covariates.
  
  
  
  We found an association between smoking status and receipt of an opioid prescription. The effect was stronger for current smokers than former smokers, highlighting the need to determine whether smoking cessation is associated with a reduction in opioid use among veterans.
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.|Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Bastian
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.|Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Driscoll
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.|Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Alicia A
authors.initials: AA
authors.lastname: Heapy
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.|Yale University School of Medicine, New Haven, Connecticut.
authors.forename: William C
authors.initials: WC
authors.lastname: Becker
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.|Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Goulet
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Eric C
authors.initials: EC
authors.lastname: DeRycke
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Elliottnell
authors.initials: E
authors.lastname: Perez
authors.affiliation: University of Connecticut School of Medicine, Farmington, Connecticut.
authors.forename: Shaina M
authors.initials: SM
authors.lastname: Lynch
authors.affiliation: VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts.|University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Mattocks
authors.affiliation: University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Aimee R
authors.initials: AR
authors.lastname: Kroll-Desrosiers
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.|Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Brandt
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Melissa
authors.initials: M
authors.lastname: Skanderson
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Harini
authors.initials: H
authors.lastname: Bathulapalli
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.|Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Sally G
authors.initials: SG
authors.lastname: Haskell
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000073865:Cigarette Smoking / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends; D014728:Veterans / Q000523:psychology; D058014:Veterans Health / Q000639:trends*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Opioids; Pain; Smoking; Tobacco; Veterans