2012 HSR&D/QUERI National Conference Abstract
1106 — Prevalence and Trends in Benzodiazepine and Concomitant Opioid Analgesics Use among VA Patients with PTSD, 2003-2010
Hawkins EJ, and Malte CA, VA Puget Sound Healthcare System; Imel ZE, University of Utah; Saxon AJ, Grossbard JR, and Kivlahan DR, VA Puget Sound Healthcare System;
The VA/DoD clinical guideline for management of posttraumatic stress disorder (PTSD) recommends against routine use of benzodiazepines, citing multiple risks including risk of adverse events with concomitant use of drugs or medications such as opioid analgesics. However, little is known about co-prescription of benzodiazepines and opioids among patients with PTSD. This study examines the prevalence and trends of benzodiazepine and concomitant opioid use from fiscal years 2003 to 2010.
This retrospective study included 64,872 patients with PTSD diagnoses from outpatient visits or inpatient admissions at facilities in VA Northwest Veterans Integrated Service Network (VISN 20) from 2003- 2010. Annual prevalence of any dual use was defined as any prescription for benzodiazepines and opioids, and chronic dual use was defined as > 90 days’ supply of both medications, in a year. Gender-specific logistic regressions were fit to estimate any and chronic dual use with adjustment for age and test for linear trends over the 8 years.
In 2010, the age-adjusted prevalence of any dual use of benzodiazepines and opioids was 15.6% (15.2%-16.0%) among men with PTSD, and 23.8% (22.3%-25.3%) among women with PTSD. There was a significant increase in chronic use over 8 years for men from 5.1% (4.8%-5.4%) to 7.6% (7.3%-7.9%), [adjusted odds ratio (AOR) = 1.06 (1.05-1.07)] and for women from 5.6% (4.6%-6.8%) to 10.1% (9.1%-11.2%), [AOR = 1.08 (1.06-1.11)]. In 2010, 47% (45.2 – 47.9) of those prescribed benzodiazepines >90 days were also prescribed opioids >90 days. Supply of both benzodiazepines and opioids exceeded 180 days for 66.0% (64.1%-67.8%) of patients with chronic dual use in 2010 and the mean days of overlap was 238.3 (SD = 97.9).
Chronic use of benzodiazepines and opioids increased significantly among men and women with PTSD from 2003 to 2010. In 2010, nearly 1 in 12 men and 1 in 10 women with PTSD in VISN 20 were chronic users of benzodiazepines and opioids.
Common benzodiazepine and concomitant opioid use suggests the need for risk management systems and research on the efficacy and safety of these concurrent medications.