G S Sayuk1,2,3, N Kanuri1, C P Gyawali1, B M Gott2, B D Nix1, R A Rosenheck4,5. 1. Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA. 2. Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA. 3. Gastroenterology Section, John Cochran Veterans Affairs Medical Center, St. Louis, MO, USA. 4. Department of Veterans Affairs, New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA. 5. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
Abstract
BACKGROUND: While opioid prescriptions have increased alarmingly in the United States (US), their use for unexplained chronic gastrointestinal (GI) pain (eg, irritable bowel syndrome) carries an especially high risk for adverse effects and questionable benefit. AIM: To compare opioid use among US veterans with structural GI diagnoses (SGID) and those with unexplained GI symptoms or functional GI diagnoses (FGID), a group for whom opioids have no accepted role. METHODS: Veterans Health Administration (VHA) administrative data from fiscal year 2012 were used to identify veterans with diagnostic codes recorded for SGID and FGID. This cohort study examined VHA pharmacy data to compare groups receiving ≥ 1 opioid prescription during the year and number of prescriptions filled. Bivariate and multiple logistic regression analyses adjusted for potential confounding factors (demographics, medical diagnoses, social factors) and identified potential mediators (service use, psychiatric comorbidity) of opioid use in these groups. RESULTS: A greater proportion of veterans with FGID received an opioid prescription during fiscal year 2012 (36.0% of 272 431) compared to only 28.9% of 1 223 744 in the SGID group (Relative Risk [RR] = 1.25). In multivariate logistic regression, personality disorders and drug abuse (OR 1.23 for each group), recent homelessness (OR 1.22), psychotropic medication fills (OR 1.55) and emergency department encounters (OR 1.21) were independently associated with opioid prescription use. CONCLUSIONS: Despite the potential for adverse consequences, opioids more often are prescribed for veterans with chronic, unexplained GI symptoms compared to those with structural diagnoses. Psychiatric comorbidities and frequent healthcare encounters mediate some of the opioid use risk.
BACKGROUND: While opioid prescriptions have increased alarmingly in the United States (US), their use for unexplained chronic gastrointestinal (GI) pain (eg, irritable bowel syndrome) carries an especially high risk for adverse effects and questionable benefit. AIM: To compare opioid use among US veterans with structural GI diagnoses (SGID) and those with unexplained GI symptoms or functional GI diagnoses (FGID), a group for whom opioids have no accepted role. METHODS: Veterans Health Administration (VHA) administrative data from fiscal year 2012 were used to identify veterans with diagnostic codes recorded for SGID and FGID. This cohort study examined VHA pharmacy data to compare groups receiving ≥ 1 opioid prescription during the year and number of prescriptions filled. Bivariate and multiple logistic regression analyses adjusted for potential confounding factors (demographics, medical diagnoses, social factors) and identified potential mediators (service use, psychiatric comorbidity) of opioid use in these groups. RESULTS: A greater proportion of veterans with FGID received an opioid prescription during fiscal year 2012 (36.0% of 272 431) compared to only 28.9% of 1 223 744 in the SGID group (Relative Risk [RR] = 1.25). In multivariate logistic regression, personality disorders and drug abuse (OR 1.23 for each group), recent homelessness (OR 1.22), psychotropic medication fills (OR 1.55) and emergency department encounters (OR 1.21) were independently associated with opioid prescription use. CONCLUSIONS: Despite the potential for adverse consequences, opioids more often are prescribed for veterans with chronic, unexplained GI symptoms compared to those with structural diagnoses. Psychiatric comorbidities and frequent healthcare encounters mediate some of the opioid use risk.
Authors: Mohamed Noureldin; Peter D R Higgins; Shail M Govani; Shirley Cohen-Mekelburg; Brooke C Kenney; Ryan W Stidham; Jennifer F Waljee; Akbar K Waljee Journal: Aliment Pharmacol Ther Date: 2018-11-14 Impact factor: 8.171
Authors: Salva N Balbale; Lishan Cao; Itishree Trivedi; Jonah J Stulberg; Katie J Suda; Walid F Gellad; Charlesnika T Evans; Neil Jordan; Laurie A Keefer; Bruce L Lambert Journal: Am J Health Syst Pharm Date: 2022-01-05 Impact factor: 2.980
Authors: Salva N Balbale; Lishan Cao; Itishree Trivedi; Jonah J Stulberg; Katie J Suda; Walid F Gellad; Charlesnika T Evans; Bruce L Lambert; Laurie A Keefer; Neil Jordan Journal: Mil Med Date: 2021-08-28 Impact factor: 1.563