Long-term use of opioid prescriptions by veterans

Veteran patients who receive long-term opioid prescriptions generally are treated with modest and stable medication dosages, according to an article in the November 22 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

“The long-term use of opioids for the treatment of chronic pain of nonmalignant [noncancerous] origin has been generally supported by specialists in pain management as a less than ideal but often necessary and humane course of treatment,” according to background information in the article. Long-term opioid use can by complicated by problematic dose increases, drug dependency, and toxic effects.

John A. Hermos, M.D., from Boston University School of Public Health, and colleagues analyzed pharmacy and clinical databases in order to determine characteristics of prescribing patterns and to identify potential high-risk opioid prescribing. Data on durations, doses, and dose changes of oxycodone/acetaminophen and concurrent use of long-acting opioids, benzodiazepines, tricyclic antidepressants, and anticonvulsants were obtained from the Veterans Integrated Service Network for the New England region (VISN 1) from January 1998 through June 2001.

The researchers found that during the study period, 47,302 patients received 177,840 prescriptions (initial and renewed prescriptions) for short-acting opioid medications, and 6,936 received 53,083 prescriptions for long-acting opioids. Two thousand one hundred ninety-five patients (31 percent with cancer) received oxycodone/acetaminophen for more than nine months at an average prescribed dose of 3.9 tablets per day, without significant changes in daily prescribed average dose over time. Patients with cancer were more likely to receive other long-acting opioids simultaneously. In those without cancer, high daily average doses were associated with duration, older age, HIV and/or AIDS, and with prescription of benzodiazepines and long-acting opioids.

“In veteran patients who received long-term oxycodone/acetaminophen prescriptions, mean daily doses were typically modest and stable, likely reflecting a selection of patients with successful, long-term management,” the authors write. “Among patients without cancer, however, associations of higher oxycodone/acetaminophen doses with benzodiazepine prescriptions, psychogenic pain, alcohol abuse, and HIV/AIDS may portend opioid prescription management problems.”