Traumatic Brain Injury and Opioid Overdose Among Post-9/11 Veterans With Long-Term Opioid Treatment of Chronic Pain. Issue 3 (May 2020)

• Record Type: Journal Article
• Authors: Fonda, Jennifer R.; Gradus, Jaimie L.; Brogly, Susan B.; McGlinchey, Regina E.; Milberg, William P.; Fredman, Lisa
• Other Names: Caplan Bruce section editor.; Bogner Jennifer section editor.; Brenner Lisa section editor.; Malec James section editor.
• Is Part Of: Journal of head trauma rehabilitation. Volume 35:Issue 3(2020)
• Publication Date: 2020-05
• Subjects: chronic pain -- opioid overdose -- traumatic brain injury -- veterans; Brain damage -- Patients -- Rehabilitation -- Periodicals; Brain damage -- Periodicals; 617.4810443
• DOI: 10.1097/HTR.0000000000000546
• Languages: English
• ISSNs: 0885-9701

Abstract

Abstract : Objective: To evaluate the association between traumatic brain injury (TBI) and nonfatal opioid overdose, and the role of psychiatric conditions as mediators of this association. Setting: Post-9/11 veterans receiving care at national Department of Veterans Affairs (VA) facilities from 2007 to 2012. Participants: In total, 49 014 veterans aged 18 to 40 years receiving long-term opioid treatment of chronic noncancer pain. Design: Longitudinal cohort study using VA registry data. Main Measures: TBI was defined as a confirmed diagnosis (28%) according to VA comprehensive TBI evaluation; no TBI was defined as a negative primary VA TBI screen (ie, no head injury). Nonfatal opioid overdose was defined using ICD-9 ( International Classification of Diseases, Ninth Revision ) codes. We performed demographic-adjusted Cox proportional hazards regression. We quantified the impact of co-occurring and individual psychiatric conditions (mood, anxiety, substance use, and posttraumatic stress disorder) on this association using mediation analyses. Results: Veterans with TBI had more than a 3-fold increased risk of opioid overdose compared with those without (adjusted hazards ratio [aHR] = 3.22; 95% confidence interval [CI], 2.13-4.89). This association was attenuated in mediation analyses of any co-occurring psychiatric condition (aHR = 1.77; 95% CI, 1.25-2.52) and individual conditions (aHR range, 1.52-2.95). Conclusion: TBI status, especially in the context of comorbid conditions, should be considered in clinical decisions regarding long-term use of opioids in patients with chronic pain. Abstract : Supplemental Digital Content is Available in the Text.