title: Pharmacoepidemiologic analyses of opioid use among OEF/OIF/OND veterans.
abstract: There is a great deal of concern about opioid use in veterans, particularly those who served in Afghanistan (OEF) and Iraq (OIF and OND). The current study provides a detailed pharmacoepidemiologic analysis of opioid use among OEF/OIF/OND veterans from FY09 to FY12. Data from 3 data repositories from the Veterans Health Administration (VHA) were used to describe demographic, clinical, and medication characteristics associated with opioid use among OEF/OIF/OND veterans and among those with TBI. Logistic regression models were used to identify risks associated with chronic opioid use in FY12. Approximately 23% of all OEF/OIF/OND veterans and 35% of those with TBI received any opioid medications. Most received moderate doses ranging from 26 to 30 mg morphine equivalent dose daily. Median days of opioid use for all OEF/OIF/OND veterans were 30 to 40 days. Factors associated with chronic use in both groups included young age, male sex, white race, being married, and living in rural areas. A diagnosis of PTSD (odds ratio [OR] = 1.22, P < 0.0001), major depressive disorder (OR = 1.14, P < 0.0001), and tobacco use disorder (OR = 1.18, P < 0.0001) were strongly associated with chronic opioid use. Back pain was also strongly associated with chronic use (OR = 2.50, P < 0.0001). As pain severity increased the odds of chronic opioid use also increased: mild pain (OR = 3.76, P < 0.0001), moderate pain (OR = 6.80, P < 0.0001), and severe pain (OR = 8.49, P < 0.0001). Opioid use among OEF/OIF/OND veterans is characterized by moderate doses that are used over relatively long periods of time by a minority of veterans.
authors.affiliation: aDepartment of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA bCenter for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA cDivision of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA dDepartment of Psychiatry, School of Medicine, University of Washington, Seattle, WA, USA eHSR&D, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA fBehavioral Health Epidemiology Program, RTI International, Research Triangle Park, NC, USA gBehavioral Health Services, St. Luke's Health System, Twin Falls, ID, USA.
authors.forename: Teresa J
authors.initials: TJ
authors.lastname: Hudson
authors.forename: Jacob T
authors.initials: JT
authors.lastname: Painter
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Martin
authors.forename: Mark A
authors.initials: MA
authors.lastname: Austen
authors.forename: James S
authors.initials: JS
authors.lastname: Williams
authors.forename: John C
authors.initials: JC
authors.lastname: Fortney
authors.forename: Mark D
authors.initials: MD
authors.lastname: Sullivan
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Edlund
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000453:epidemiology / Q000517:prevention & control*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D010147:Pain Measurement / Q000706:statistics & numerical data; D017891:Pharmacoepidemiology; D015995:Prevalence; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid