Opioid dosing trends over eight years among US Veterans with musculoskeletal disorders after returning from service in support of?recent conflicts

摘要

Abstract Purpose To examine long-term opioid dosing trends among Veterans with chronic pain. Methods We identified 79,015 Veterans with musculoskeletal disorders who were dispensed greater than or equal to 1 opioid prescriptions between 2002 and 2009 after returning from recent conflicts. Opioid-dosing trends were examined using a generalized estimating equation while accounting for patient characteristics, temporal and geographic confounding. Results In total, 472,819 opioid prescriptions were dispensed (mean?±?standard deviation: 6.0?±?10.1 per Veteran). Both average daily morphine equivalents (MEs/d) and the proportion of high-dose prescribing (greater than 100?ME/d) increased from baseline period (2002–2004) to 2006, then remained relatively stable. Veterans with extended persistent (greater than or equal to 40?days over 1–2 episodes) and extended intermittent (greater than or equal to 40?days over greater than or equal to three episodes) dispensing patterns received more high-dose prescriptions than those dispensed prescriptions less than 40?days, with adjusted odds ratios (95%?confidence interval) of 7.2 (6.0–8.8) and 3.6 (3.0–4.3), respectively. Posttraumatic stress disorder and other mental health diagnoses were associated with 30% increased odds of high-dose prescribing. Conclusions The average daily dose of opioid prescriptions and the likelihood of high-dose prescribing to these Veterans appeared to increase from 2002 to 2006, then remained relatively stable through 2009. Veterans on opioid prescriptions for extended duration or with mental health diagnoses tend to receive higher dose therapy. Highlights ? This study examined dispensing history of opioid prescriptions among 79,015 US Veterans with musculoskeletal pain and found an escalating dosing trend from 2002 to 2006 followed by a plateau through 2009 after accounting for individual, temporal, and geographic confounding. ? Veterans who were dispensed opioid prescriptions for extended duration tend to receive higher average daily dose and greater number of high-dose prescriptions. ? Veterans with a diagnosis of posttraumatic stress disorders, major depressive disorders, or substance use disorders were associated with higher dose therapy.