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2015 HSR&D/QUERI National Conference Abstract

3021 — Prevalence and Trends of Concurrent Opioid Analgesic and Benzodiazepine Use Among Veterans Affairs Patients with PTSD, 2003 - 2011

Hawkins EJ, Center of Excellence in Substance Abuse Treatment and Education; Malte CA, Center of Excellence in Substance Abuse Treatment and Education; Grossbard JR, Center of Excellence in Substance Abuse Treatment and Education; Saxon AJ, Center of Excellence in Substance Abuse Treatment and Education;

Patients with posttraumatic stress disorder (PTSD) have numerous complex symptoms, including anxiety, insomnia and co-occurring pain. Opioid analgesics and benzodiazepines are commonly prescribed to treat these symptoms, but there are growing concerns that long-term use of these medications may pose serious risks with limited therapeutic benefit. Little is known about the trends of long-term concurrent use or the prevalence of high-risk conditions such as substance use disorders, suicide risk, breathing-related disorders, and age > 65 or practices such as prescribing opioid doses exceeding 100mg/day morphine equivalents in this population. Study objectives were to examine trends in annual prevalence of long-term concurrent opioid and benzodiazepine use among patients with PTSD and estimate the prevalence of high-risk conditions and prescribing practices among concurrent users of these medications.

This retrospective review of pharmacy records included 66,210 patients with PTSD diagnoses from outpatient visits or inpatient admissions at facilities in the VA Integrated Service Network (VISN 20) from 2003-2011. Long-term concurrent use was defined as overlapping opioid and benzodiazepine prescriptions for > 90 consecutive days. Socio-demographic and clinical covariates were obtained from VA administrative data. Gender-specific logistic regressions estimated long-term concurrent use of these medications and tested for linear trends over 9-years.

The trend in age-adjusted long-term concurrent opioid and benzodiazepine use over 9-years increased from 3.6% (95% confidence interval, 3.3-3.9) to 5.5%(5.3-5.8), [adjusted odds ratio (AOR) = 1.05 (1.04-1.06)], in men and from 3.9%(3.0-5.0) to 7.0%(6.2-7.9), [AOR = 1.07 (1.05-1.10)], in women. In 2011, 17.1% of long-term concurrent users were prescribed morphine-equivalent daily doses of opioids > 100mg and 49.4% had a documented high-risk condition, with COPD (21.3%) the most common, followed by substance use disorders (18.0%), age > 65 (11.3%), sleep apnea (10.9%) and suicide risk (8.4%).

Despite known risks associated with prescribing opioids and benzodiazepines concurrently, the adjusted prevalence of long-term concurrent use rose significantly among men and women with PTSD in VISN 20 over a nine-year period, with one-half of concurrent users having a high-risk condition in FY11.

Common use of these medications among patients with high-risk conditions suggests comprehensive strategies are needed to identify and monitor patients at increased risk for adverse outcomes.