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Patterns of opioid use for chronic noncancer pain in the Veterans Health Administration from 2009 to 2011

Edlund, Mark, J.a,b,*; Austen, Mark, A.c; Sullivan, Mark, D.d; Martin, Bradley, C.c,e; Williams, James, S.c; Fortney, John, C.c,f,g; Hudson, Teresa, J.c,f

doi: 10.1016/j.pain.2014.08.033
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Among Veterans Health Administration patients with chronic noncancer pain, chronic opioid therapy occurs frequently, but the median daily dose is usually modest.

Although opioids are frequently prescribed for chronic noncancer pain (CNCP) among Veterans Health Administration (VHA) patients, little has been reported on national opioid prescribing patterns in the VHA. Our objective was to better characterize the dosing and duration of opioid therapy for CNCP in the VHA. We analyzed national VHA administrative and pharmacy data for fiscal years 2009 to 2011. For individuals with CNCP diagnoses and any opioid use in the fiscal year, we calculated the distribution of individual mean daily opioid dose, individual total days covered with opioids in a year, and individual total opioid dose in a year. We also investigated the factors associated with being in the top 5% of individuals for total opioid dose in a year, which we term receipt of high-volume opioids. About half of the patients with CNCP received opioids in a given fiscal year. The median daily dose was 21 mg morphine equivalents. Approximately 4.5% had a mean daily dose higher than 120 mg morphine equivalents. The median days covered in a year was 115 to 120 days in these years for those receiving opioids. Fifty-seven percent had at least 90 days covered with opioids per year. Major depression and posttraumatic stress disorder were positively associated with receiving high-volume opioids, but nonopioid substance use disorders were not. Among VHA patients with CNCP, chronic opioid therapy occurs frequently, but for most patients, the average daily dose is modest. Doses and duration of therapy were unchanged from 2009 to 2011.

aBehavioral Health Epidemiology Program, RTI International, 3040 Cornwallis Rd, PO Box 12194, Research Triangle Park, NC 27709-2194, USA

bBehavioral Health Services, St Luke’s Health System, 228 Shoup Ave W, Twin Falls, ID 83301, USA

cHSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Ft Roots Dr, Bldg 58, North Little Rock, AR 72114, USA

dDepartment of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195-6560, USA

eDivision of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, 4301 W Markham St, #522, Little Rock, AR 72205, USA

fDepartment of Psychiatry, Division of Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St, #755, Little Rock, AR 72205, USA

gSouth Central Mental Illness, Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, 2200 Ft Roots Dr, Bldg 58, North Little Rock, AR 72114, USA

*Corresponding author at: 3040 Cornwallis Rd, PO Box 12194, Research Triangle Park, NC 27709-2194, USA. Tel.: +1 (208) 308 2073; fax: +1 (208) 814 7940.

E-mail: medlund@rti.org

Submitted May 10, 2014; revised August 21, 2014; accepted August 26, 2014.

© 2014 International Association for the Study of Pain
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