Vets With Mental Health Issues More Likely to Get Opioid Pain Meds – With Serious Consequences
Iran and Afghanistan war veterans with mental health diagnoses, particularly PTSD, are more likely to be prescribed opioid drugs to treat their pain — and experience issues like overdose, abuse, and injuries as a result.
By Amy Solomon
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TUESDAY, Mar. 6, 2012 —According to the Department of Veteran Affairs, about 11 to 20 percent of troops returning from Iraq and Afghanistan are struggling with post-traumatic stress disorder (PTSD), and more than half also experience problems with chronic pain. Now a new study finds that many veterans with mental health issues, particularly PTSD, are being prescribed powerful prescription painkillers that put them at high risk of overdose, accidents, self-inflicted injuries, and other serious consequences.
The report, published in the March 7 issue of the , involved over 100,000 Iraq and Afghanistan veterans who were diagnosed with non-cancer-related pain within a year of entering the VA medical system. Researchers found that those with mental health diagnoses, including PTSD, depression, anxiety, and alcohol or drug abuse issues, were significantly more likely to be prescribed opioid medications. Of that group, veterans with PTSD were also much more likely to be on higher doses of the drug, be taking sedative hypnotics (like benzodiazepines) at the same time, and to request early refills. The study authors also found that having PTSD and taking opioids increased the likelihood of serious clinical outcomes, including wounds, opioid- and alcohol-related accidents and overdoses, and self-inflicted injuries.
Opioids include drugs such as oxycodone (OxyContin), hydrocodone (Vicodin), and codeine. Although their use for treating chronic pain has nearly doubled since 1994, according to studies cited in the JAMA piece, the rate of overdose and abuse has also skyrocketed. Per the U.S. Centers for Disease Control and Prevention, more than 40 people die every day from overdoses involving opioid medications — a greater death toll than that of heroin and cocaine combined.
Misuse and abuse of prescription pain medications has also gone up among the military. A Department of Defense survey that included 28,546 respondents found that prescription drug abuse increased from 4 percent in 2005 to 11 percent in 2008. Overall, 17 percent of those surveyed had misused pain medications, meaning that they took them without a doctor's prescription, in greater amounts or more often than prescribed, or to get high. An analysis of the survey results presented at the annual conference of the American Society of Addiction Medicine concluded that the strongest predictor of military prescription drug misuse was having received a pain med prescription within the past month or past year.
Veterans of the most recent wars may be at especially high risk for both pain issues and PTSD because of advances in medical science and better protective gear — meaning that many are now surviving battlefield conflicts that would have been fatal in previous wars. A 2009 article published in theJournal of Rehabilitation Research & Developmentreviewed medical records of 340 Iraq and Afghanistan vets and found that 42 percent were simultaneously diagnosed with chronic pain (especially in the back and head) and PTSD, as well as symptoms persisting after traumatic brain injuries.
One issue may be that most veterans tend to use the VA primary care system rather than seeking specialized treatment for mental health issues. As the study authors note, primary care physicians, including those in the VA system, often lack specialized training in treating pain and PTSD simultaneously. But clinical practice guidelines developed by the VA emphasize a multidisciplinary approach to treating both pain and PTSD that includes both medications and non-pharmaceutical interventions like therapy and stress management.
"When we talked to Iraq and Afghanistan veterans about our concerns, often they're very willing and open to try other alternatives to opiate pain medications," said lead author Karen Seal, MD, MPH, in a video accompanying the JAMA article (see above).
Video: Why We Need to Talk About Veteran Mental Health
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