A large new study of U.S. military veterans found that over half who were prescribed opioids to treat chronic pain continued to use them long-term. Post-traumatic stress disorder (PTSD), tobacco use, being married and being prescribed opioids at high doses were all factors that increased the likelihood of a veteran using opioids chronically.
The study looked at nearly 960,000 veterans who received an opioid prescription at a Veterans Healthcare Administration (VHA) facility in 2009.
Of those, 52% used opioids for 90 days or more. Veterans are frequently prescribed opioids long term to treat painful conditions related to their military service.
A preliminary analysis showed that certain factors were more likely to be present in veterans who continued to use opioids chronically. They include PTSD, smoking, being married, having multiple chronic pain conditions, being prescribed multiple opioids, and opioid doses above 100 mg per day.
Some of the findings surprised researchers. Previous studies found that mental health problems and drug abuse increased the likelihood of a veteran using opioids chronically. But that was not the case in this study, which found that veterans with those conditions were more likely to stop using opioids. Opioid discontinuation was defined as no opioid use for at least 6 months.
“Unlike other samples, it appears that mental-health disorders and substance-use disorders are associated with increased rates of discontinuation in the VA,” said Mark Sullivan, MD, who led a team of researchers from the University of Washington, the University of Arkansas Medical Sciences, and the Research Triangle Institute in Research Triangle Park, N.C.
“The exception is tobacco use, which is associated with a decreased likelihood of discontinuation,” Sullivan said.
Funding for the study came from the National Institute on Drug Abuse.
A recent study found that injured veterans returning from Iraq and Afghanistan with PTSD were much more likely to be prescribed opiate painkillers than other vets with chronic pain, according to researchers at the San Francisco VA Center and the University of California, San Francisco. Veterans who were prescribed opioids also had a significantly higher risk of an overdose, suicide and violent injury.
Another study of veterans found that long-term use of opioid pain medicine significantly raised their risk of developing major depression.
Researchers at Saint Louis University studied the medical records of nearly 50,000 veterans who had no history of opioid use or depression, but were subsequently prescribed opioid painkillers. They found that patients who remained on opioids for 180 days or longer had a 53% increased risk of developing depression compared to patients who never took opioids.