Ling Han1, Heather Allore2, Joseph Goulet3, Harini Bathulapali4, Melissa Skanderson4, Cynthia Brandt3, Sally Haskell3, Erin Krebs5. 1. Yale School of Medicine, Department of Internal Medicine, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT. Electronic address: ling.han@yale.edu. 2. Yale School of Medicine, Department of Internal Medicine, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT. 3. VA Connecticut Healthcare System, West Haven, CT; Yale School of Medicine, Departments of Psychiatry, Medicine and Emergency Medicine, New Haven, CT. 4. VA Connecticut Healthcare System, West Haven, CT. 5. Minneapolis VA Health Care System, Minneapolis, MN; Department of Medicine, University of Minnesota Medical School, Minneapolis.
Abstract
PURPOSE: To examine long-term opioid dosing trends among Veterans with chronic pain. METHODS: We identified 79,015 Veterans with musculoskeletal disorders who were dispensed greater than or equal to 1 opioid prescriptions between 2002 and 2009 after returning from recent conflicts. Opioid-dosing trends were examined using a generalized estimating equation while accounting for patient characteristics, temporal and geographic confounding. RESULTS: In total, 472,819 opioid prescriptions were dispensed (mean ± standard deviation: 6.0 ± 10.1 per Veteran). Both average daily morphine equivalents (MEs/d) and the proportion of high-dose prescribing (greater than 100 ME/d) increased from baseline period (2002-2004) to 2006, then remained relatively stable. Veterans with extended persistent (greater than or equal to 40 days over 1-2 episodes) and extended intermittent (greater than or equal to 40 days over greater than or equal to three episodes) dispensing patterns received more high-dose prescriptions than those dispensed prescriptions less than 40 days, with adjusted odds ratios (95% confidence interval) of 7.2 (6.0-8.8) and 3.6 (3.0-4.3), respectively. Posttraumatic stress disorder and other mental health diagnoses were associated with 30% increased odds of high-dose prescribing. CONCLUSIONS: The average daily dose of opioid prescriptions and the likelihood of high-dose prescribing to these Veterans appeared to increase from 2002 to 2006, then remained relatively stable through 2009. Veterans on opioid prescriptions for extended duration or with mental health diagnoses tend to receive higher dose therapy.
PURPOSE: To examine long-term opioid dosing trends among Veterans with chronic pain. METHODS: We identified 79,015 Veterans with musculoskeletal disorders who were dispensed greater than or equal to 1 opioid prescriptions between 2002 and 2009 after returning from recent conflicts. Opioid-dosing trends were examined using a generalized estimating equation while accounting for patient characteristics, temporal and geographic confounding. RESULTS: In total, 472,819 opioid prescriptions were dispensed (mean ± standard deviation: 6.0 ± 10.1 per Veteran). Both average daily morphine equivalents (MEs/d) and the proportion of high-dose prescribing (greater than 100 ME/d) increased from baseline period (2002-2004) to 2006, then remained relatively stable. Veterans with extended persistent (greater than or equal to 40 days over 1-2 episodes) and extended intermittent (greater than or equal to 40 days over greater than or equal to three episodes) dispensing patterns received more high-dose prescriptions than those dispensed prescriptions less than 40 days, with adjusted odds ratios (95% confidence interval) of 7.2 (6.0-8.8) and 3.6 (3.0-4.3), respectively. Posttraumatic stress disorder and other mental health diagnoses were associated with 30% increased odds of high-dose prescribing. CONCLUSIONS: The average daily dose of opioid prescriptions and the likelihood of high-dose prescribing to these Veterans appeared to increase from 2002 to 2006, then remained relatively stable through 2009. Veterans on opioid prescriptions for extended duration or with mental health diagnoses tend to receive higher dose therapy.
Authors: Mark J Edlund; Bradley C Martin; Ming-Yu Fan; Jennifer Brennan Braden; Andrea Devries; Mark D Sullivan Journal: J Pain Symptom Manage Date: 2010-06-25 Impact factor: 3.612
Authors: Roger Chou; Gilbert J Fanciullo; Perry G Fine; Jeremy A Adler; Jane C Ballantyne; Pamela Davies; Marilee I Donovan; David A Fishbain; Kathy M Foley; Jeffrey Fudin; Aaron M Gilson; Alexander Kelter; Alexander Mauskop; Patrick G O'Connor; Steven D Passik; Gavril W Pasternak; Russell K Portenoy; Ben A Rich; Richard G Roberts; Knox H Todd; Christine Miaskowski Journal: J Pain Date: 2009-02 Impact factor: 5.820
Authors: Michael Von Korff; Michael Von Korff; Kathleen Saunders; Gary Thomas Ray; Denise Boudreau; Cynthia Campbell; Joseph Merrill; Mark D Sullivan; Carolyn M Rutter; Michael J Silverberg; Caleb Banta-Green; Constance Weisner Journal: Clin J Pain Date: 2008 Jul-Aug Impact factor: 3.442
Authors: Sally G Haskell; Cynthia A Brandt; Erin E Krebs; Melissa Skanderson; Robert D Kerns; Joseph L Goulet Journal: Pain Med Date: 2009-10 Impact factor: 3.750
Authors: Joseph L Goulet; Robert D Kerns; Matthew Bair; William C Becker; Penny Brennan; Diana J Burgess; Constance M Carroll; Steven Dobscha; Mary A Driscoll; Brenda T Fenton; Liana Fraenkel; Sally G Haskell; Alicia A Heapy; Diana M Higgins; Rani A Hoff; Ula Hwang; Amy C Justice; John D Piette; Patsi Sinnott; Laura Wandner; Julie A Womack; Cynthia A Brandt Journal: Pain Date: 2016-08 Impact factor: 7.926
Authors: Alicia E López-Martínez; Ángela Reyes-Pérez; Elena Rocío Serrano-Ibáñez; Rosa Esteve; Carmen Ramírez-Maestre Journal: World J Clin Cases Date: 2019-12-26 Impact factor: 1.337