TY - JOUR
T1 - Duration of opioid prescriptions predicts incident nonmedical use of prescription opioids among U.S. veterans receiving medical care
AU - Barry, Declan T.
AU - Marshall, Brandon D.L.
AU - Becker, William C.
AU - Gordon, Adam J.
AU - Crystal, Stephen
AU - Kerns, Robert D.
AU - Gaither, Julie R.
AU - Gordon, Kirsha S.
AU - Justice, Amy C.
AU - Fiellin, David A.
AU - Edelman, E. Jennifer
N1 - Funding Information:
This work was supported by grantsfrom the National Institute on Alcohol Abuse and Alcoholism (NIAAA: U10-AA013566 , U01-AA020795 , U01-AA020790 , U24-AA020794 , U10-AA013566 , and P01-AA019072 ), the National Institute of Allergy and Infectious Diseases ( P30-AI042853 ), and the US Department of Veterans Affairs ( CIN 13-047 ). Dr. Julie Gaither is supported by the National Institute on Drug Abuse ( F31-DA035567 ). E. Jennifer Edelman was supported by grants from the National Institute on Drug Abuse ( K12-DA033312 , R01-DA040471 ) during the conduct of this work. Dr. Brandon Marshall is supported by the National Institute on Drug Abuse ( DP2-DA040236 ). Dr. Stephen Crystal is supported by AHRQ awards 1U19HS021112 and R18-HS023258 . The sponsors had no role in the study design; data collection, analysis or interpretation; the writing of the manuscript; or in the decision to submit the paper for publication. We would like to acknowledge the veterans who participate in the Veterans Aging Cohort Study (VACS) and the study coordinators and staff at each VACS site and at the West Haven Coordinating Center. We would also like to thank Melissa Skanderson for her assistance and support during data acquisition. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the funding agencies or affiliated institutions, including the Department of Veterans Affairs or the United States government.
Publisher Copyright:
© 2018 Elsevier B.V.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Background/Aims: Although nonmedical use of prescription opioids (NMUPO) is a public health problem, few studies have examined the new-onset NMUPO in clinical populations. We estimated NMUPO incidence among veterans in medical care who had received prescription opioid medication and examined correlates of new-onset NMUPO. Design: Prospective cohort study. Setting: Veterans Health Administration primary care and infectious disease clinics in Atlanta, Baltimore, Bronx, Houston, Los Angeles, Manhattan, Pittsburgh, and Washington, DC. Participants: Patients enrolled in the Veterans Aging Cohort Study wave 3 (2005–2007) who received prescription opioids in the previous year and without lifetime NMUPO were followed at waves 4 and 5 (2008–2011). Measurements: Cox proportional hazards regression was used to examine the relationship between duration of prescription opioid receipt and incident NMUPO, adjusting for demographics, alcohol and tobacco use, substance use disorders, psychiatric and medical diagnoses, and medication-related characteristics. Findings: Among eligible participants (n = 815), the median age was 52 (IQR = 47–58) and 498 (59.8%) were Black; 122 (15.0%) reported new-onset NMUPO, for an incidence rate of 5.0 per 100 person-years. In a multivariable Cox model, compared to <30 days, receipt of prescription opioids for 30–180 days (adjusted hazard ratio [AHR] = 1.65 95% CI: 1.06, 2.58) or >180 days (AHR = 1.99, 95% CI: 1.21, 3.29) was associated with incident NMUPO. Conclusions: Duration of prescription opioid receipt is a risk factor for incident NMUPO among veterans receiving medical care. Providers who prescribe opioids should monitor for NMUPO, especially among those with a longer duration of opioid therapy.
AB - Background/Aims: Although nonmedical use of prescription opioids (NMUPO) is a public health problem, few studies have examined the new-onset NMUPO in clinical populations. We estimated NMUPO incidence among veterans in medical care who had received prescription opioid medication and examined correlates of new-onset NMUPO. Design: Prospective cohort study. Setting: Veterans Health Administration primary care and infectious disease clinics in Atlanta, Baltimore, Bronx, Houston, Los Angeles, Manhattan, Pittsburgh, and Washington, DC. Participants: Patients enrolled in the Veterans Aging Cohort Study wave 3 (2005–2007) who received prescription opioids in the previous year and without lifetime NMUPO were followed at waves 4 and 5 (2008–2011). Measurements: Cox proportional hazards regression was used to examine the relationship between duration of prescription opioid receipt and incident NMUPO, adjusting for demographics, alcohol and tobacco use, substance use disorders, psychiatric and medical diagnoses, and medication-related characteristics. Findings: Among eligible participants (n = 815), the median age was 52 (IQR = 47–58) and 498 (59.8%) were Black; 122 (15.0%) reported new-onset NMUPO, for an incidence rate of 5.0 per 100 person-years. In a multivariable Cox model, compared to <30 days, receipt of prescription opioids for 30–180 days (adjusted hazard ratio [AHR] = 1.65 95% CI: 1.06, 2.58) or >180 days (AHR = 1.99, 95% CI: 1.21, 3.29) was associated with incident NMUPO. Conclusions: Duration of prescription opioid receipt is a risk factor for incident NMUPO among veterans receiving medical care. Providers who prescribe opioids should monitor for NMUPO, especially among those with a longer duration of opioid therapy.
KW - Analgesics
KW - HIV
KW - Opioids
KW - Pain
KW - Veterans
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U2 - 10.1016/j.drugalcdep.2018.07.008
DO - 10.1016/j.drugalcdep.2018.07.008
M3 - Article
C2 - 30176548
AN - SCOPUS:85054072158
SN - 0376-8716
VL - 191
SP - 348
EP - 354
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
ER -