Prevalence and correlates of coprescribing anxiolytic medications with extensive prescription opioid use in Veterans Health Administration patients with metastatic cancer

Declan T. Barry, PhD; Mehmet Sofuoglu, MD; Robert D. Kerns, PhD; Ilse R. Wiechers, MD; Robert A. Rosenheck, MD

doi:10.5055/jom.2016.0341

Authors

Declan T. Barry, PhD
Mehmet Sofuoglu, MD
Robert D. Kerns, PhD
Ilse R. Wiechers, MD
Robert A. Rosenheck, MD

DOI:

https://doi.org/10.5055/jom.2016.0341

Keywords:

opioid, psychotropic, cancer, oncology, veteran

Abstract

Objective: To examine the prevalence and correlates of concomitant anxiolytic prescription fills in Veterans Health Administration (VHA) patients with metastatic cancer who have extensive prescription opioid use.

Design, Setting, and Participants: National VHA data for fiscal year 2012 were used to identify veterans diagnosed with metastatic cancer (ICD-9 codes 196-199) who also had extensive prescription opioid use (at least 10 opioid prescriptions during the year, comprising the highest 29 percent of opioid users). Bivariate and multivariate analyses were used to examine correlates of receiving anxiolytic medication among veterans with metastatic cancer and extensive prescription opioid use.

Results: Of the 5,950 veterans with metastatic cancer and extensive prescription opioid use, 51 percent also received anxiolytic medication, of whom 64 percent had a medical indication and 85 percent had a psychiatric or medical indication for psychotropics. Of those with extensive prescription opioid use who filled an anxiolytic, 64 percent also received antidepressants and 38 percent received three or more classes of psychotropic medication (ie, polypharmacy). In multivariate analyses, factors associated with receipt of an anxiolytic included any anxiety disorder, insomnia, the prescription of antidepressants or antipsychotics, bipolar disorder, younger age, more emergency department visits, and greater number of opioid prescriptions.

Conclusions: VHA patients with metastatic cancer and extensive prescription opioid use who are prescribed anxiolytics are likely to have a Food and Drug Administration-approved indication for psychotropics, and anxiolytics in particular, but represent a clinically vulnerable group which merits careful monitoring.

Author Biographies

Declan T. Barry, PhD

Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; APT Foundation Pain Treatment Services, New Haven, Connecticut

Mehmet Sofuoglu, MD

Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Veterans Health Administration Mental Illness Research, Education and Clinical Center, West Haven, Connecticut

Robert D. Kerns, PhD

Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Pain Research, Informatics, Multimorbidities and Education Center of Innovation VA Connecticut Healthcare System, West Haven, Connecticut.

Ilse R. Wiechers, MD

VA Connecticut Healthcare System, West Haven, Connecticut; Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut

Robert A. Rosenheck, MD

Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Veterans Health Administration Mental Illness Research, Education and Clinical Center, West Haven, Connecticut

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