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Health Services Research & Development

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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3019 — Predictors of Opioid Initiation and Long Term Use among Veterans with Chronic Pain

Dobscha SK (Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VAMC), Morasco BJ (Mental Health and Clinical Neurosciences Division, Portland VAMC), Macey TA (Mental Health and Clinical Neurosciences Division, Portland VAMC), Duckart J (Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VAMC), Deyo RA (Department of Family Medicine and Public Health, Oregon Health & Science University)

Little is known about the predictors of initiating prescription opioids or of chronic opioid therapy (COT), particularly among veterans. We sought to identify predictors of opioid initiation and COT among veterans with chronic non-cancer pain.

Using VA administrative data, we identified 5,961 veterans from VISN 20 who had 3 or more NRS pain intensity scores > = 4 within a 12-month period, the last score (index date) occurring in 2008, and who had not been prescribed opioids in the prior 12 months. We collected information for the 12 months following index dates. Multivariate regression was used to compare veterans not prescribed opioids over the study year to those prescribed any opioid, and to those prescribed COT ( > 90 consecutive days).

During the study year, 34% of the sample received one or more opioid prescriptions, and 5% received COT. Veterans prescribed COT were younger, had greater pain intensity scores, and greater global illness severity compared to veterans not prescribed opioids or prescribed opioids < 90 days. Significant differences were noted among groups in rates of comorbid psychiatric and substance use disorders (SUDs), with patients prescribed COT having the highest rates. Of patients prescribed COT, 29% were prescribed long-acting opioids, 37% were administered one or more urine drug screens, and 24% were prescribed benzodiazepines. In multivariate models, adjusting for age, sex, and baseline pain scores, major depression (OR 1.24 [1.10-1.39]; 1.48 [1.14-1.93]), nicotine dependence (OR 1.34 [1.17-1.53]; 2.02 [1.53-2.67], and SUD (OR 1.13 [0.96-1.32]; 1.42 [1.04-1.95) were associated with receiving any opioid prescription and with receiving COT, respectively.

Psychiatric disorders including SUDs and nicotine dependence predicted initiation and continuation of opioid treatment in this veteran patient population. Many veterans prescribed COT do not receive guideline-recommended care, including long-acting formulations and urine drug screening; many receive concurrent prescriptions for benzodiazepines.

Initiation of opioids among veterans with chronic pain is common; however, most do not take them long-term. Efforts are needed to improve provision of guideline-concordant pain care for veterans receiving COT. More research is needed about outcomes of opioid initiations as well as how providers make decisions to initiate and continue opioids.

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