Opioid use in young veterans
Keywords:opioids, veterans, pain, chronic, prevalence, monitoring, safety, efficacy
AbstractPurpose: Data suggest an increase in prescription opioid abuse in recent years. Young veterans represent a group with major risk factors for prescription opioid abuse. The objectives of this study are: (A) to determine the prevalence of chronic opioid use in young veterans over time; (B) to describe the prescribing patterns and monitoring of chronic opioid therapy in young veterans; and (C) to assess opioid management within Veterans Affairs Palo Alto Health Care System (VAPAHCS) with an emphasis on effectiveness and safety.
Methods: This is a Veterans Affairs Research and Development (R&D) Committee and IRB-approved retrospective, single-center study of young veterans aged 18-30 years on chronic opioid therapy during the study years January 1, 2003, to October 1, 2008. A subset of the study population who were receiving long-acting opioids for a minimum of 6 months was included in the effectiveness and safety analyses. Data were obtained from the Veterans Integrated Service Network (VISN 21) data warehouse, outpatient prescription records, and from electronic chart review.
Results: The prevalence of chronic opioid use in young veterans has increased from 3 percent in 2003 to 4.5 percent in 2007. Patients on average were exposed to two Zdifferent opioids and had three different opioid prescribers. Nearly 80 percent of the opioid prescriptions during the study were prescribed by primary care providers and less than 1 percent was from pain specialists. Only 31 percent of patients on chronic opioids had undergone urine drug testing and only 5 percent had signed opioid treatment agreements. No difference in median pain score was observed following initiation of long-acting opioid therapy, and 22 percent of patients (4 of 18) met the prespecified definition of being a responder to long-acting opioid therapy. Five patients (28 percent) on long-acting opioids experienced adverse drug reactions.
Conclusion: The prevalence of chronic opioid use in young veterans has been on the rise in recent years. Young veterans receiving care at VAPAHCS have often had multiple opioid prescribers and have trialed multiple opioid analgesics. Many improvements in appropriate monitoring and management of these patients can be made, which may include providing more training to current staff, the development of an opioid refill clinic, and greater utilization of the pain management specialists. Further larger study is warranted to identify successful strategies for improving prescribing and monitoring of opioids as well as potential predictors of response to chronic long-acting opioid therapy.
Gallagher RM: Biopsychosocial pain medicine and mind-brain-body science. Phys Med Rehabil Clin N Am. 2004; 15: 855-882.
Federation of State Medical Boards of the United States, Inc.: Model policy for the use of controlled substances for the treatment of pain. Available at http://www.fsmb.org/PAIN/modelpolicy.html. Accessed July 10, 2009.
Wiedemer NL, Harden PS, Arndt IO, et al.: The opioid renewal clinic: A primary care, managed approach to opioid therapy in chronic pain patients at risk for substance abuse. Pain Med. 2007; 8(7): 573-584.
Chou R, Fanciullo GJ, Fine PG, et al.: Opioid treatment guidelines. Clinical guidelines for the use of chronic opioids therapy in chronic noncancer pain. J Pain. 2009; 10: 113-130.
McCabe SE, Cranford JA, West BT: Trends in prescription drug abuse and dependence, co-occurrence with other substance use disorders, and treatment utilization: Results from two national surveys. Addict Behav. 2008; 33: 1297-1305.
Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA): Results from the 2005 National Survey on Drug Use and Health: National Findings. Available at http://www.oas.samhsa.gov/nsduh/2k5nsduh/2k5results.pdf. Accessed February 22, 2010.
Edlund MJ, Steffick D, Hudson T, et al.: Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain. 2007; 129: 355-362.
Becker WC, Sullivan LE, Tetrault JM, et al.: Non-medical use, abuse and dependence on prescription opioids among U.S. adults: Psychiatric, medical and substance use correlates. Drug Alcohol Depend. 2008; 94: 38-47.
Webster LR, Webster RM: Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the opioid risk tool. Pain Med. 2005;6: 432-442.
Cohen SP, Griffith S, Larkin TM, et al.: Presentation, diagnoses, mechanism of injury, and treatment of soldiers injured in Operation Iraqi Freedom: An epidemiological study conducted at two military pain management centers. Anesth Analg. 2005; 101: 1098-1103.
Clark ME, Bair MJ, Buckenmaier CC III, et al.: Pain and combat injuries in soldiers returning from Operations Enduring Freedom and Iraqi Freedom: Implications for research and practice. J Rehabil Res Dev. 2007; 44: 179-194.
Hoge CW, Auchterlonie JL, Milliken CS: Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. J Am Med Assoc. 2006; 295: 1023-1032.
Benyamin R, Trescot AM, Datta S, et al.: Opioid complications and side effects. Pain Physician. 2008; 11: S105-S120.
Daniell HW: Hypogonadism in men consuming sustained-action oral opioid. J Pain. 2002; 3: 377-384.
Daniell HW: DHEAS deficiency during consumption of sustained-action prescribed opioids: Evidence for opioid-induced inhibition of adrenal androgen production. J Pain. 2006: 7(12): 901-907.
Cole BE: Neuroendocrine implications of opioid therapy. Curr Pain Headache Rep. 2007; 11: 89-92.
Colameco S: Opioid-induced sexual dysfunction: Causes, diagnosis, & treatment. Pain treatment topics. 2008. Available at http://pain-topics.org/pdf/Colameco-Opioids-SexDysfunction.pdf. Accessed July 9, 2009.
Upshur CC, Luckmann RS, Savageau JA: Primary care provider concerns about management of chronic pain in community clinic populations. J Gen Intern Med. 2006; 21: 652-655.
Roth CS, Burgess DJ, Mahowald ML: Medical residents’ beliefs and concerns about using opioids to treat chronic cancer and noncancer pain: A pilot study. J Rehabil Res Dev. 2007; 44(2): 263-270.
Mitchinson AR, Kerr EA, Krein SL: Management of chronic noncancer pain by VA primary care providers: When is pain control a priority? Am J Manag Care. 2008; 14(2): 77-84.
Potter M, Schafer S, Gonzalez-Mendez E, et al.: Opioids for chronic nonmalignant pain: Attitudes and practices of primary care physicians in the UCSF/Stanford Collaborative Research Network. University of California, San Francisco. J Fam Pract. 2001; 50(2): 145-151.
Dobscha SK, Corson K, Flores JA, et al.: Veterans affairs primary care clinicians’ attitudes toward chronic pain and correlates of opioid prescribing rates. Pain Med. 2008; 9(5): 564-571.
Gallagher RM: Pain medicine and primary care: A community solution to pain as a public health problem. Med Clin North Am. 1999; 83: 555-585.
Primm BJ, Perez L, Dennis GC, et al.: Managing pain: The challenge of the underserved populations: Appropriate use versus abuse and diversion. J Natl Med Assoc. 2004; 96: 1152-1161.
Fishman SM, Wilsey B, Yang J, et al.: Adherence monitoring and drug surveillance in chronic opioid therapy. J Pain Symptom Manage. 2000; 20: 293-307.
Gourlay DL, Heitt HA, Almahrezi A: Universal precautions in pain medicine: A rational approach to the treatment of chronic pain. Pain Med. 2005; 6(2): 107-112.
Trescot AM, Boswell MV, Atluri SL, et al.: Opioid guidelines in the management of chronic non-cancer pain. Pain Physician. 2006; 9: 1-40.
David CJ: Chronic pain prevalence and analgesic prescribing in a general medical population. J Pain Symptom Manage. 2002; 23: 131-137.
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