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

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.

Keywords: Dispensing pattern; Dynamic cohort; Electronic pharmacy records; Mental health diagnoses; Musculoskeletal pain; Opioid-dosing trends; Veterans.