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Veterans With Mental Health Issues Receive More Opioids

Risks of opioid use and adverse clinical outcomes especially high in veterans with PTSD

TUESDAY, March 6 (HealthDay News) -- Iraq and Afghanistan war veterans with mental health diagnoses, particularly posttraumatic stress disorder (PTSD), are more likely to receive prescription opioid medications for pain-related conditions, have higher-risk opioid use patterns, and have increased adverse clinical outcomes associated with opioid use, compared to veterans with no mental health diagnoses, according to a study published in the March 7 issue of the Journal of the American Medical Association.

Karen H. Seal, M.D., M.P.H., of the San Francisco Veterans Affairs Medical Center, and colleagues retrospectively studied 141,029 Iraq and Afghanistan veterans who received at least one non-cancer-related pain diagnosis within one year of entering the Department of Veterans Affairs health care system from Oct. 1, 2005, through Dec. 31, 2010.

The researchers found that 15,676 veterans were prescribed opioids within one year of their initial pain diagnosis. Compared with 6.5 percent of veterans without mental health disorders, 17.8 percent of veterans with PTSD and 11.7 percent of veterans with other mental health diagnoses were significantly more likely to receive opioids for pain diagnoses (adjusted relative risk [aRR], 2.58 and 1.74, respectively). Of those who were prescribed pain medication, veterans with PTSD were more likely than those without mental health disorders to receive higher-dose opioids (22.7 versus 15.9 percent; aRR, 1.42); receive two or more opioids concurrently (19.8 versus 10.7 percent; aRR, 1.87); receive sedative hypnotics concurrently (40.7 versus 7.6 percent; aRR, 5.46); or obtain early opioid refills (33.8 versus 20.4 percent; aRR, 1.64). All veterans who received prescription opioids had an increased risk of adverse clinical outcomes compared with veterans who did not receive opioid prescriptions (9.5 versus 4.1 percent; RR, 2.33), and this risk was most pronounced in veterans with PTSD.

"Among U.S. veterans of Iraq and Afghanistan, mental health diagnoses, especially PTSD, were associated with an increased risk of receiving opioids for pain, high-risk opioid use, and adverse clinical outcomes," the authors write.

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