Citation

Grossbard JR, Malte CA, Saxon AJ, Hawkins EJ. Drug Alcohol Depend. 2014; 142: 24-32.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.drugalcdep.2014.03.020

PMID

unavailable

Abstract

BACKGROUND: Opioid therapy alone or in combination with benzodiazepines poses safety concerns among patients with substance use disorders (SUD). Guidelines for opioid therapy recommend SUD treatment and enhanced monitoring, especially in patients with additional risk factors, but information on monitoring practices is sparse. This study estimated high-risk conditions - psychiatric comorbidity, suicide risk, and age <35 and ≥65 - and described clinical monitoring among patients with SUD who were newly prescribed opioids alone and concurrent with benzodiazepines long-term.

METHODS: This study included VA Northwest Veterans Network patients with SUD who started opioids only (n= 980) or benzodiazepines and opioids concurrently (n= 353) long-term (≥90 days) in 2009-2010. Clinical characteristics, outpatient visits and urine drug screens (UDS) documented within 7-months after starting medications were extracted from VA data.

RESULTS: Approximately 67% (95% CI: 64-70) of opioids only and 94% (92-97) of concurrent medications groups had ≥1 psychiatric diagnoses. Prevalences of suicide risk and age <35 and ≥65 were 7% (5-8), 6% (5-8) and 18% (15-20) among the opioids only group, and 20% (16-24), 8% (5-11) and 13% (9-16) among the concurrent medications group. Among patients prescribed opioids only and medications concurrently, 87% and 91% attended primary care, whereas 28% and 26% attended SUD specialty-care. Overall, 30% and 48% of opioids only and concurrent medications groups engaged in mental health or SUD care, and 35% and 39% completed UDS.

CONCLUSIONS: Improvements in clinical monitoring are needed as many VA patients with SUD and comorbid risks who initiate opioid therapy do not receive sufficient mental health/SUD care or UDS monitoring. © 2014.

Language: en

Keywords

Humans; Risk Factors; Adult; Aged; Female; Male; Middle Aged; adult; human; mental health; suicide; female; male; Substance-Related Disorders; aged; Primary Health Care; complication; addiction; Pain; comorbidity; veteran; Veterans; Benzodiazepines; pain; Analgesics, Opioid; Substance use disorders; risk factor; substance abuse; article; major clinical study; primary medical care; mental disease; prescription; patient monitoring; priority journal; middle aged; opiate; psychiatric diagnosis; benzodiazepine derivative; primary health care; urinalysis; drug screening; high risk patient; outpatient care; opiate substitution treatment; narcotic analgesic agent; Clinical monitoring; Opioid therapy