VA patients with high numbers of opioid prescriptions: A national study of sociodemographic and diagnostic characteristics, health service, and psychotropic medication use

Abstract

Background and Objectives: Prescription opioid use is a major public health concern, particularly among military personnel and veterans. This study used administrative data on Veterans Health Administration users to identify characteristics associated with high numbers of opioid prescriptions. Methods: Veterans Health Administration patients (n= 5,300,000) who attended Z1 outpatient visit during fiscal year 2010 were classified into 5 groups: no opioid prescriptions, 1 to 2, 3 to 10, 10 to 19, and >20 opioid prescriptions filled during the year. Bivariate comparisons and logistic regression were used to identify sociodemographic, diagnostic characteristics, health service, and psychotropic medication usage that differentiated the high opioid group (>20) from those who used none. Results: On bivariate analysis, the patients in the high opioid group (1% of sample) were more likely to be diagnosed with metastatic cancer, other medical illnesses, and various forms of pain, drug abuse, alcohol abuse, mood disorders, and anxiety. Psychotropic prescriptions were also associated with high opioid use. Logistic regression showed that drug abuse, depressive disorders, and dual diagnosis were independently associated with high prescription opioid use. Medical outpatient visits but not mental health or emergency room visits, and antidepressant prescriptions but not other psychotropics, were more independently associated with high opioid use. Service during the recent Middle East conflicts was associated with lower risk of high opioid use. Discussion and Conclusions: Drug use disorders, depression, and antidepressant medication prescriptions were independently associated with extensive opioid use. Providers should be attuned to high rates of comorbid drug use and depression and concomitant antidepressants among patients with high opioid prescription use.