Pharmacoepidemiologic analyses of opioid use among OEF/OIF/OND veterans
Hudson, T. J., Painter, J. T., Martin, B. C., Austen, M. A., Williams, J. S., Fortney, J. C., ... Edlund, M. J. (2017). Pharmacoepidemiologic analyses of opioid use among OEF/OIF/OND veterans. Pain, 158(6), 1039-1045. DOI: 10.1097/j.pain.0000000000000874
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.