Patterns and Correlates of Prescription Opioid Use in OEF/OIF Veterans with Chronic Noncancer Pain

Authors

  • Tara A. Macey PhD,

    Corresponding author
    1. Mental Health and Clinical Neurosciences Division
    2. Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, Portland, Oregon
    3. Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
    Search for more papers by this author
  • Benjamin J. Morasco PhD,

    1. Mental Health and Clinical Neurosciences Division
    2. Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
    Search for more papers by this author
  • Jonathan P. Duckart MPS,

    1. Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, Portland, Oregon
    Search for more papers by this author
  • Steven K. Dobscha MD

    1. Mental Health and Clinical Neurosciences Division
    2. Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, Portland, Oregon
    3. Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
    Search for more papers by this author

Steven K. Dobscha, MD, Mental Health and Clinical Neurosciences Division, Portland VA Medical Center (P3_MHADM), 3710 SW US Veterans Hospital Road, Portland, OR 97239, USA. Tel: 503-220-8262x56490; Fax: 503-273-5367; E-mail: steven.dobscha@va.gov.

Abstract

Objectives.  Little is known about the treatment Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans receive for chronic noncancer pain (CNCP). We sought to describe the prevalence of prescription opioid use, types, and doses of opioids received and to identify correlates of receiving prescription opioids for CNCP among OEF/OIF veterans.

Design.  Retrospective review of Veterans Affairs (VA) administrative data.

Setting.  Ambulatory clinics within a VA regional health care network.

Patients.  OEF/OIF veterans who had at least three elevated pain screening scores within a 12-month period in 2008. Within this group, those prescribed opioids (N = 485) over the next 12 months were compared with those not prescribed opioids (N = 277). In addition, patients receiving opioids short term (<90 days, N = 284) were compared with patients receiving them long term (≥90 consecutive days, N = 201).

Results.  Of 762 OEF/OIF veterans with CNCP, 64% were prescribed at least one opioid medication over the 12 months following their index dates. Of those prescribed an opioid, 59% were prescribed opioids short term and 41% were prescribed opioids long term. The average morphine-equivalent opioid dose for short-term users was 23.7 mg (standard deviation [SD] = 20.5) compared with 40.8 mg (SD = 36.1) for long-term users (P < 0.001). Fifty-one percent of long-term opioid users were prescribed short-acting opioids only, and one-third were also prescribed sedative hypnotics. In adjusted analyses, diagnoses of low back pain, migraine headache, posttraumatic stress disorder, and nicotine use disorder were associated with an increased likelihood of receiving an opioid prescription.

Conclusion.  Prescription opioid use is common among OEF/OIF veterans with CNCP and is associated with several pain diagnoses and medical conditions.

Ancillary