Prevalence and correlates of coprescribing anxiolytic medications with extensive prescription opioid use in Veterans Health Administration patients with metastatic cancer

Objective: To examine the prevalence and correlates of concomitant anxiolytic prescription fills in Veterans Health Administration (VHA) patients with metastatic cancer who have extensive prescription opioid use.Design, Setting, and Participants: National VHA data for fiscal year 2012 were used to identify veterans diagnosed with metastatic cancer (ICD-9 codes 196-199) who also had extensive prescription opioid use (at least 10 opioid prescriptions during the year, comprising the highest 29 percent of opioid users). Bivariate and multivariate analyses were used to examine correlates of receiving anxiolytic medication among veterans with metastatic cancer and extensive prescription opioid use.Results: Of the 5,950 veterans with metastatic cancer and extensive prescription opioid use, 51 percent also received anxiolytic medication, of whom 64 percent had a medical indication and 85 percent had a psychiatric or medical indication for psychotropics. Of those with extensive prescription opioid use who filled an anxiolytic, 64 percent also received antidepressants and 38 percent received three or more classes of psychotropic medication (ie, polypharmacy). In multivariate analyses, factors associated with receipt of an anxiolytic included any anxiety disorder, insomnia, the prescription of antidepressants or antipsychotics, bipolar disorder, younger age, more emergency department visits, and greater number of opioid prescriptions.Conclusions: VHA patients with metastatic cancer and extensive prescription opioid use who are prescribed anxiolytics are likely to have a Food and Drug Administration-approved indication for psychotropics, and anxiolytics in particular, but represent a clinically vulnerable group which merits careful monitoring.

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Prescription Opioid Use Among Seriously Mentally Ill Veterans Nationally in the Veterans Health Administration

Community Mental Health Journal ◽

10.1007/s10597-015-9939-4 ◽

2015 ◽

Vol 52 (2) ◽

pp. 165-173 ◽

Cited By ~ 3

Author(s):

Nickie Mathew ◽

Robert A. Rosenheck

Keyword(s):

Mentally Ill ◽

Veterans Health Administration ◽

Prescription Opioid ◽

Veterans Health ◽

Health Administration ◽

Opioid Use ◽

Seriously Mentally Ill ◽

Prescription Opioid Use

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Opioid use disorder and homelessness in the Veterans Health Administration: The challenge of multimorbidity

Journal of Opioid Management ◽

10.5055/jom.2018.0447 ◽

2018 ◽

Vol 14 (3) ◽

pp. 171-182 ◽

Cited By ~ 10

Author(s):

Theddeus Iheanacho, MD ◽

Elina Stefanovics, PhD ◽

Robert Rosenheck, MD

Keyword(s):

Risk Factor ◽

Service Use ◽

Veterans Health Administration ◽

Opioid Use Disorder ◽

Fiscal Year ◽

Veterans Health ◽

Health Administration ◽

Opioid Use ◽

Agonist Therapy ◽

Homeless Veterans

Objective: The aim of this study is to estimate the prevalence and sociodemographic and clinical correlates of opioid use disorder (OUD), a major cause of morbidity and mortality in the United States, among homeless veterans nationally in the Veterans Health Administration (VHA).Design: Administrative data on 256,404 veterans who were homeless and/or had OUD in fiscal year 2012 were analyzed to evaluate OUD as a risk factor for homelessness along with associated characteristics, comorbidities, and patterns of service use. Bivariate analyses and logistic regression were used to compare homeless veterans with OUD to veterans with OUD but no homelessness and homeless veterans with no OUD.Results: Altogether 17.9 percent of homeless VHA users were diagnosed with OUD and 34.6 percent of veterans with OUD were homeless. The risk ratio (RR) for homelessness among veterans with OUD was 28.7. Homeless veterans with OUD, compared to nonhomeless veterans with OUD showed extensive multimorbidity with greater risk for HIV (RR = 1.57), schizophrenia (RR = 1.62), alcohol use disorder (RR = 1.67), and others. Homeless veterans with OUD also showed more multimorbidity and used more services than homeless veterans without OUD. Homeless and nonhomeless OUD veterans used opiate agonist therapy at similar, but very low rates (13 and 15 percent).Conclusions: OUD is a major risk factor for homelessness. Homeless veterans with OUD have high levels of multimorbidity and greater service use than veterans with either condition alone. Tailored, facilitated access to opioid agonist therapy may improve outcomes for these vulnerable veterans.

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Sex Differences in Opioid Use Disorder Prevalence and Multimorbidity Nationally in the Veterans Health Administration

Journal of Dual Diagnosis ◽

10.1080/15504263.2021.1904162 ◽

2021 ◽

pp. 1-11

Author(s):

MacKenzie R. Peltier ◽

Mehmet Sofuoglu ◽

Ismene L. Petrakis ◽

Elina Stefanovics ◽

Robert A. Rosenheck

Keyword(s):

Sex Differences ◽

Veterans Health Administration ◽

Opioid Use Disorder ◽

Veterans Health ◽

Health Administration ◽

Opioid Use

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Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation

BMJ ◽

10.1136/bmj.m283 ◽

2020 ◽

pp. m283 ◽

Cited By ~ 12

Author(s):

Elizabeth M Oliva ◽

Thomas Bowe ◽

Ajay Manhapra ◽

Stefan Kertesz ◽

Jennifer M Hah ◽

...

Keyword(s):

Opioid Analgesic ◽

Veterans Health Administration ◽

Fiscal Year ◽

Veterans Health ◽

Health Administration ◽

Opioid Treatment ◽

Risk Of Death ◽

Length Of Treatment ◽

Increased Risk ◽

Stopping Treatment

Abstract Objective To examine the associations between stopping treatment with opioids, length of treatment, and death from overdose or suicide in the Veterans Health Administration. Design Observational evaluation. Setting Veterans Health Administration. Participants 1 394 102 patients in the Veterans Health Administration with an outpatient prescription for an opioid analgesic from fiscal year 2013 to the end of fiscal year 2014 (1 October 2012 to 30 September 2014). Main outcome measures A multivariable Cox non-proportional hazards regression model examined death from overdose or suicide, with the interaction of time varying opioid cessation by length of treatment (≤30, 31-90, 91-400, and >400 days) as the main covariates. Stopping treatment with opioids was measured as the time when a patient was estimated to have no prescription for opioids, up to the end of the next fiscal year (2014) or the patient’s death. Results 2887 deaths from overdose or suicide were found. The incidence of stopping opioid treatment was 57.4% (n = 799 668) overall, and based on length of opioid treatment was 32.0% (≤30 days), 8.7% (31-90 days), 22.7% (91-400 days), and 36.6% (>400 days). The interaction between stopping treatment with opioids and length of treatment was significant (P<0.001); stopping treatment was associated with an increased risk of death from overdose or suicide regardless of the length of treatment, with the risk increasing the longer patients were treated. Hazard ratios for patients who stopped opioid treatment (with reference values for all other covariates) were 1.67 (≤30 days), 2.80 (31-90 days), 3.95 (91-400 days), and 6.77 (>400 days). Descriptive life table data suggested that death rates for overdose or suicide increased immediately after starting or stopping treatment with opioids, with the incidence decreasing over about three to 12 months. Conclusions Patients were at greater risk of death from overdose or suicide after stopping opioid treatment, with an increase in the risk the longer patients had been treated before stopping. Descriptive data suggested that starting treatment with opioids was also a risk period. Strategies to mitigate the risk in these periods are not currently a focus of guidelines for long term use of opioids. The associations observed cannot be assumed to be causal; the context in which opioid prescriptions were started and stopped might contribute to risk and was not investigated. Safer prescribing of opioids should take a broader view on patient safety and mitigate the risk from the patient’s perspective. Factors to address are those that place patients at risk for overdose or suicide after beginning and stopping opioid treatment, especially in the first three months.

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Perioperative Opioid Prescribing Patterns and Readmissions After Total Knee Arthroplasty in a National Cohort of Veterans Health Administration Patients

Pain Medicine ◽

10.1093/pm/pnz154 ◽

2019 ◽

Vol 21 (3) ◽

pp. 595-603 ◽

Cited By ~ 2

Author(s):

Seshadri C Mudumbai ◽

Paul Chung ◽

Nick Nguyen ◽

Brooke Harris ◽

J David Clark ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Hospital Readmission ◽

Veterans Health Administration ◽

Care Utilization ◽

Veterans Health ◽

Day Hospital ◽

Health Administration ◽

Opioid Use ◽

Short Acting ◽

Total Knee

Abstract Objective Among Veterans Health Administration (VHA) patients who undergo total knee arthroplasty (TKA) nationally, what are the underlying readmission rates and associations with perioperative opioid use, and are there associations with other factors such as preoperative health care utilization? Methods We retrospectively examined the records of 5,514 TKA patients (primary N = 4,955, 89.9%; revision N = 559, 10.1%) over one fiscal year (October 1, 2010–September 30, 2011) across VHA hospitals nationwide. Opioid use was classified into no opioids, tramadol only, short-acting only, or any long-acting. We measured readmission within 30 days and the number of days to readmission within 30 days. Extended Cox regression models were developed. Results The overall 30-day hospital readmission rate was 9.6% (N = 531; primary 9.5%, revision 11.1%). Both readmitted patients and the overall sample were similar on types of preoperative opioid use. Relative to patients without opioids, patients in the short-acting opioids only tier had the highest risk for 30-day hospital readmission (hazard ratio = 1.38, 95% confidence interval = 1.14–1.67). Preoperative opioid status was not associated with 30-day readmission. Other risk factors for 30-day readmission included older age (≥66 years), higher comorbidity and diagnosis-related group weights, greater preoperative health care utilization, an urban location, and use of preoperative anticonvulsants. Conclusions Given the current opioid epidemic, the routine prescribing of short-acting opioids after surgery should be carefully considered to avoid increasing risks of 30-day hospital readmissions and other negative outcomes, particularly in the context of other predisposing factors.

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