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14-03-2012 | Psychology | Article

US veterans of Iraq and Afghanistan with mental health disorders show risky opioid use

MedWire News: US veterans of Iraq and Afghanistan with mental health disorders are more likely to be prescribed opioids and to misuse their prescription than veterans with no such disorder, shows research published in JAMA.

"Iraq and Afghanistan veterans with pain- and PTSD- [posttraumatic stress disorder] prescribed opioids may be at particularly high risk of prescription opioid misuse given the high occurrence of substance use disorders among veterans with PTSD," explain Karen Seal (University of California, San Francisco, USA) and colleagues.

"Despite media reports of overdose in these veterans with pain- and PTSD-prescribed opioids, little is known about the association of mental health disorders and PTSD with patterns of prescription opioid use and clinical outcomes."

Of the 141,029 veterans who entered the Veterans Affairs Health Care System from 2005-2008, 51% received at least one mental health diagnosis over a 1-year follow-up. The study included 15,676 veterans who had been prescribed opioids within a year of their initial pain diagnosis.

The researchers found that 17.8% of veterans with PTSD and 11.7% of veterans with mental health diagnoses other than PTSD received opioids for a pain diagnosis, compared with 6.5% of veterans without mental health disorders.

Of the veterans who were prescribed pain medication, those with PTSD were 1.42 times more likely to receive higher-dose opioids than those without mental health disorders (22.7 vs 15.9%). They were also more likely to receive two or more sedatives at once, receive hypnotics in addition, or obtain early opioid refills, compared with those without mental health disorders.

Seal and team also found that receiving prescription opioids was associated with a significant increased risk for a raft of clinical outcomes in veterans across all mental health categories. These included accidents resulting in wounds or injuries; opioid-related accidents; alcohol- and non-opioid-related drug-related accidents and overdose; self-inflicted injuries; and violence-related injuries.

The researchers conclude: "Extra care should be taken when prescribing opioids to relieve their [veterans] distress. These patients may benefit from biopsychosocial models of pain care including evidence-based pharmacologic therapies and nonopioid analgesics.

"Integrated treatments that target both mental health disorders and pain simultaneously are effective for both problems and may decrease harms resulting from opioid therapy."

By Chloe McIvor

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