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Cited by 515Opioid Use Disorder TreatmentPain Management and Opioid UseSubstance Abuse Treatment and Outcomes

The DOI matches its Crossref record; 49 of the 49 references it cites were found in a registry or an index.

Association of Mental Health Disorders With Prescription Opioids and High-Risk Opioid Use in US Veterans of Iraq and Afghanistan

Seal, Karen H., Shi, Ying, Cohen, Gregory, Cohen, Beth E., Maguen, Shira, Krebs, Erin E., Neylan, Thomas C.·2012·JAMA
DOI 10.1001/jama.2012.234
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Abstract

CONTEXT: Record numbers of Iraq and Afghanistan veterans survive their war injuries and yet continue to experience pain and mental health problems, particularly posttraumatic stress disorder (PTSD). Little is known about the association of mental health disorders and prescription opioid use. OBJECTIVE: To investigate the effect of mental health disorders, particularly PTSD, on risks and adverse clinical outcomes associated with prescription opioid use. DESIGN: Retrospective cohort study involving 141,029 Iraq and Afghanistan veterans who received at least 1 non-cancer-related pain diagnosis within 1 year of entering the Department of Veterans Affairs (VA) health care system from October 1, 2005, through December 31, 2010. MAIN OUTCOME MEASURES: Independent association of mental health disorders and the prescription of opioids, higher risk opioid use, and adverse clinical outcomes (eg, accidents and overdose) within 1 year of receiving a pain-related diagnosis. RESULTS: A total of 15,676 veterans were prescribed opioids within 1 year of their initial pain diagnosis. Compared with 6.5% of veterans without mental health disorders, 17.8% (adjusted relative risk [RR], 2.58; 95% CI, 2.49-2.67) of veterans with PTSD and 11.7% (adjusted RR, 1.74; 95% CI, 1.67-1.82) with other mental health diagnoses but without PTSD were significantly more likely to receive opioids for pain diagnoses. Of those who were prescribed pain medication, veterans with PTSD were more likely than those without mental health disorders to receive higher-dose opioids (22.7% vs 15.9%, adjusted RR, 1.42; 95% CI, 1.31-1.54), receive 2 or more opioids concurrently (19.8% vs 10.7%, adjusted RR, 1.87; 95% CI, 1.70-2.06), receive sedative hypnotics concurrently (40.7% vs 7.6%, adjusted RR, 5.46; 95% CI, 4.91-6.07), or obtain early opioid refills (33.8% vs 20.4%; adjusted RR, 1.64; 95% CI, 1.53-1.75). Receiving prescription opioids (vs not) was associated with an increased risk of adverse clinical outcomes for all veterans (9.5% vs 4.1%; RR, 2.33; 95% CI, 2.20-2.46), which was most pronounced in veterans with PTSD. CONCLUSION: Among US veterans of Iraq and Afghanistan, mental health diagnoses, especially PTSD, were associated with an increased risk of receiving opioids for pain, high-risk opioid use, and adverse clinical outcomes.

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Metadata

Authors
Seal, K. H., Shi, Y., Cohen, G., Cohen, B. E., Maguen, S., Krebs, E. E., & Neylan, T. C.
Affiliations
  • San Francisco VA Medical Center (US)
  • University of California, San Francisco (US)
  • Indiana University (US)
Corresponding author
Seal, Karen H.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2012-03-07
Volume
307
Issue
9
Pages
940-7
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2012.234
OpenAlex
W1972850166
Cited by
515
References
49
Citations by year
2026: 7 · 2025: 17 · 2024: 19 · 2023: 33 · 2022: 31 · 2021: 36 · 2020: 42 · 2019: 52 · 2018: 59 · 2017: 47 · 2016: 44 · 2015: 37 · 2014: 34 · 2013: 38 · 2012: 16
FWCI
38.64
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Heart, Lung, and Blood Institute (K23HL094765)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
opioid use, post-traumatic stress disorder, mental illness, Iraq and Afghanistan veterans, opioid overdose, opioid refills, sedative-hypnotic drugs, adverse clinical outcomes, veterans' health care, pain management, opioid prescribing practices, opioid-related deaths, opioid-related hospitalizations, opioid-related emergency department visits
MeSH terms
Adult, Analgesics, Opioid, Mental Disorders, Female, Humans, Male, Opioid-Related Disorders, Pain, Retrospective Studies, Risk, Stress Disorders, Post-Traumatic, United States, Veterans, Cohort Studies, Iraq War, 2003-2011, Prescription Drugs, Afghan Campaign 2001-, Drug Overdose

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