Opioids misuse, abuse, addiction, and overdose have become serious public health worldwide. They are also a leading cause of death in the USA. Complementary and integrative health (CIH) interventions may help prevent or reduce opioid related harms. However, an April 2016 QUERI ESP report stated that "the evidence base regarding the effectiveness of select CIH interventions for reducing opioid use is extremely limited." Strategies to identify CIH use and its effects are needed. The impact of CIH on opioid use, co-prescriptions, pain and related outcomes in VA is poorly understood. Because Veterans with PTSD are at higher risk for opioid related harms, and because of the potential mutual reinforcement of PTSD and pain symptoms, CIH may have substantial impact on decreasing rates of opioid initiation and harms. We will examine CIH use and non-use among Veterans with musculoskeletal disorders (MSD) and compare opioid and pain outcomes by PTSD status.
Our aims are to assess the impact of CIH on opioid initiation among Veterans with MSD, estimate whether the effect varies by Veterans demographic and clinical characteristics, with particular attention to Veterans with PTSD status, and to examine potential harms of CIH use.
We will use algorithms from the Musculoskeletal Disorders cohort study (CRE12-012) to identify Veterans with MSD, and identify CIH use via structured data (e.g. procedure and ICD codes) and informatics tools on unstructured data (e.g. clinical notes). We will examine acupuncture, massage, meditation/mindfulness and yoga as they are currently or likely to be integrated into routine VA care. Using structured data only, we identified 7,621 CIH users among MSD cohort entrants in FY11-FY13 (n= 309,277); of which, 21% had a PTSD diagnosis. Opioid and other medications will be identified from pharmacy data.
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Mental, Cognitive and Behavioral Disorders, Musculoskeletal Disorders
Epidemiology, Treatment - Observational, TRL - Applied/Translational
Utilization, Pain, Substance Use and Abuse, Surveillance, Technology Development