Receipt of Concurrent VA and Non-VA Opioid and Sedative-Hypnotic Prescriptions Among Post-9/11 Veterans With Traumatic Brain Injury. Issue 5 (September 2021)

• Record Type: Journal Article
• Authors: Ashraf, Alexandria J.; Gilbert, Tess A.; Holmer, Haley K.; Cook, Lawrence J.; Carlson, Kathleen F.
• Editors: Adams, Rachel Sayko
• Is Part Of: Journal of head trauma rehabilitation. Volume 36:Issue 5(2021)
• Page Start: 364
• Page End: 373
• Publication Date: 2021-09
• Subjects: analgesics -- benzodiazepines/*therapeutic use -- brain injuries -- drug overdose/epidemiology -- drug prescriptions/statistics and numerical data -- dual use -- Iraq War -- 2003-2011 -- opioid safety -- opioid/*therapeutic use -- traumatic -- VA healthcare system -- veterans/*statistics and numerical data; Brain damage -- Patients -- Rehabilitation -- Periodicals; Brain damage -- Periodicals; 617.4810443
• DOI: 10.1097/HTR.0000000000000728
• Languages: English
• ISSNs: 0885-9701

Abstract

Abstract : Supplemental Digital Content is Available in the Text. Abstract : Objective: Receipt of concurrent psychotropic prescription medications from both US Department of Veterans Affairs (VA) and non-VA healthcare providers may increase risk of adverse opioid-related outcomes among veterans with traumatic brain injury (TBI). Little is known about patterns of dual-system opioid or sedative-hypnotic prescription receipt in this population. We estimated the prevalence and patterns of, and risk factors for, VA/non-VA prescription overlap among post-9/11 veterans with TBI receiving opioids from VA providers in Oregon. Setting: Oregon VA and non-VA outpatient care. Participants: Post-9/11 veterans in Oregon with TBI who received an opioid prescription from VA providers between the years of 2014 and 2019. Design: Historical cohort study. Main Measures: Prescription overlap of VA opioids and non-VA opioids or sedative-hypnotics; proportions of veterans who received VA or non-VA opioid, benzodiazepine, and nonbenzodiazepine sedative-hypnotic prescriptions were also examined by year and by veteran characteristics. Results: Among 1036 veterans with TBI receiving opioids from the VA, 210 (20.3%) received an overlapping opioid prescription from a non-VA provider; 5.3% received overlapping benzodiazepines; and none received overlapping nonbenzodiazepine sedative-hypnotics. Proportions of veterans with prescription overlap tended to decrease over time. Veterans with other than urban versus urban addresses (OR = 1.4; 95% CI, 1.0-1.8), high versus medium average annual VA visits (OR = 1.7; 95% CI, 1.1-2.6), and VA service connection of 50% or more versus none/0% to 40% (OR = 4.3; 95% CI, 1.3-14.0) were more likely to have concurrent VA/non-VA prescriptions in bivariable analyses; other than urban remained associated with overlap in multivariable models. Similarly, veterans with comorbid posttraumatic stress disorder diagnoses were more likely to have concurrent VA/non-VA prescriptions in both bivariable and multivariable (OR = 2.1; 95% CI, 1.0-4.1) models. Conclusion: Among post-9/11 veterans with TBI receiving VA opioids, a considerable proportion had overlapping non-VA prescription medications. Providers and healthcare systems should consider all sources of psychotropic prescriptions, and risk factors for overlapping medications, to help mitigate potentially unsafe medication use among veterans with TBI.