Correlates of prescription opioid initiation and long-term opioid use in veterans with persistent pain

Steven Dobscha, Benjamin Morasco, Jonathan P. Duckart, Tara MacEy, Richard (Rick) Deyo

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Little is known about how opioid prescriptions for chronic pain are initiated. We sought to describe patterns of prescription opioid initiation, identify correlates of opioid initiation, and examine correlates of receipt of chronic opioid therapy (COT) among veterans with persistent noncancer pain. METHODS:: Using Veterans Affairs administrative data, we identified 5961 veterans from the Pacific Northwest with persistent elevated pain intensity scores who had not been prescribed opioids in the prior 12 months. We compared veterans not prescribed opioids over the subsequent 12 months with those prescribed any opioid and to those prescribed COT (>90 consecutive days). RESULTS:: During the study year, 35% of the sample received an opioid prescription and 5% received COT. Most first opioid prescriptions were written by primary care clinicians. Veterans prescribed COT were younger, had greater pain intensity, and high rates of psychiatric and substance use disorders compared with veterans in the other 2 groups. Among patients receiving COT, 29% were prescribed long-acting opioids, 37% received 1 or more urine drug screens, and 24% were prescribed benzodiazepines. Adjusting for age, sex, and baseline pain intensity, major depression [odds ratio 1.24 (1.10-1.39); 1.48 (1.14-1.93)], and nicotine dependence [1.34 (1.17-1.53); 2.02 (1.53-2.67)] were associated with receiving any opioid prescription and with COT, respectively. DISCUSSION:: Opioid initiations are common among veterans with persistent pain, but most veterans are not prescribed opioids long-term. Psychiatric disorders and substance use disorders are associated with receiving COT. Many Veterans receiving COT are concurrently prescribed benzodiazepines and many do not receive urine drug screening; additional study regarding practices that optimize safety of COT in this population is indicated.

Original languageEnglish (US)
Pages (from-to)102-108
Number of pages7
JournalClinical Journal of Pain
Volume29
Issue number2
DOIs
StatePublished - Feb 2013

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Veterans
Opioid Analgesics
Prescriptions
Pain
Therapeutics
Benzodiazepines
Substance-Related Disorders
Psychiatry
Urine
Northwestern United States
Tobacco Use Disorder
Preclinical Drug Evaluations

Keywords

  • Chronic pain
  • opioids
  • veteran

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology

Cite this

Correlates of prescription opioid initiation and long-term opioid use in veterans with persistent pain. / Dobscha, Steven; Morasco, Benjamin; Duckart, Jonathan P.; MacEy, Tara; Deyo, Richard (Rick).

In: Clinical Journal of Pain, Vol. 29, No. 2, 02.2013, p. 102-108.

Research output: Contribution to journalArticle

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abstract = "Little is known about how opioid prescriptions for chronic pain are initiated. We sought to describe patterns of prescription opioid initiation, identify correlates of opioid initiation, and examine correlates of receipt of chronic opioid therapy (COT) among veterans with persistent noncancer pain. METHODS:: Using Veterans Affairs administrative data, we identified 5961 veterans from the Pacific Northwest with persistent elevated pain intensity scores who had not been prescribed opioids in the prior 12 months. We compared veterans not prescribed opioids over the subsequent 12 months with those prescribed any opioid and to those prescribed COT (>90 consecutive days). RESULTS:: During the study year, 35{\%} of the sample received an opioid prescription and 5{\%} received COT. Most first opioid prescriptions were written by primary care clinicians. Veterans prescribed COT were younger, had greater pain intensity, and high rates of psychiatric and substance use disorders compared with veterans in the other 2 groups. Among patients receiving COT, 29{\%} were prescribed long-acting opioids, 37{\%} received 1 or more urine drug screens, and 24{\%} were prescribed benzodiazepines. Adjusting for age, sex, and baseline pain intensity, major depression [odds ratio 1.24 (1.10-1.39); 1.48 (1.14-1.93)], and nicotine dependence [1.34 (1.17-1.53); 2.02 (1.53-2.67)] were associated with receiving any opioid prescription and with COT, respectively. DISCUSSION:: Opioid initiations are common among veterans with persistent pain, but most veterans are not prescribed opioids long-term. Psychiatric disorders and substance use disorders are associated with receiving COT. Many Veterans receiving COT are concurrently prescribed benzodiazepines and many do not receive urine drug screening; additional study regarding practices that optimize safety of COT in this population is indicated.",
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