School of Medicine and Health Sciences Poster Presentations

Title

Opioid Prescribing Patterns for United States Military Veterans with a History of Musculoskeletal Injury

Document Type

Poster

Abstract Category

Drug Abuse

Keywords

Opioids, Drug Prescriptions, Military, Veterans

Publication Date

Spring 5-1-2019

Abstract

Military Veterans are at-risk for musculoskeletal injuries (MSKI) and opioid misuse. Opioid prescription rates increase with age; thus, age is important to consider in this high-risk population. Morphine milligram equivalents (MMEs) allow for comparisons between opioids of varying potencies. Currently, no studies describe the opioid prescribing patterns for different age groups of Veterans with MSKIs treated within the Veterans Health Administration (VHA). Thus, we determined the opioid prescription rates by age group and the MME rates per beneficiary. Understanding opioid prescribing patterns for this at-risk population is essential to combat the opioid epidemic. A retrospective review of VHA Managerial Cost Accounting including the National Patient Care Database was queried to identify VHA Veterans with ‚â•1 MSKI diagnosis (n=4,455,335) from FY2013-2015. Opioid prescriptions (count) for these Veterans and associated information (medication, dose) were abstracted from the Treating Specialty and Outpatient National Data Extracts Database. Prescribed MMEs were calculated. VHA beneficiaries were stratified by age group. Rates and 95% confidence intervals (CI) were calculated for opioid prescriptions and MMEs per VHA beneficiary age group. Prescription and MME rates were compared between age groups; 95% CIs not overlapping with another age group were considered significantly different. VHA Veterans (n=4,455,335; males=90.9%) diagnosed with an MSKI during the study period were provided with 21,064,631 opioid prescriptions. Opioid prescription rates differed between all age groups (lowest-to-highest: <25 [0.30 prescriptions/beneficiary; 95% CI: 0.29, 0.30], 95+, 85-94, 25-34, 75-84, 35-44, 65-74, 45-54, 55-64 [2.09 prescriptions/beneficiary; 95% CI: 2.09, 2.09]). MME rates per beneficiary differed between all age groups (lowest-to-highest: <25 [5.35 MMEs/beneficiary; 95% CI: 5.34, 5.36], 95+, 84-94, 75-84, 25-34, 35-44, 65-74, 45-54, 55-64 [41.06 MMEs/beneficiary; 95% CI: 41.05, 41.06]). Veterans aged 45-74 receive the majority of opioid prescriptions amongst Veterans with MSKI within the VHA. These findings concur with previous studies. Individuals who receive >50 MME/day have greater risk for opioid overdose. None of the age groups exceeded this threshold; however, the 55-64 group was close. Our study identified a high risk sub-population (55-64 group) within an already at-risk population; this information can help clinicians be more cognizant when prescribing opioids and help mitigate the opioid epidemic.

Open Access

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Comments

Presented at Research Days 2019.

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Opioid Prescribing Patterns for United States Military Veterans with a History of Musculoskeletal Injury

Military Veterans are at-risk for musculoskeletal injuries (MSKI) and opioid misuse. Opioid prescription rates increase with age; thus, age is important to consider in this high-risk population. Morphine milligram equivalents (MMEs) allow for comparisons between opioids of varying potencies. Currently, no studies describe the opioid prescribing patterns for different age groups of Veterans with MSKIs treated within the Veterans Health Administration (VHA). Thus, we determined the opioid prescription rates by age group and the MME rates per beneficiary. Understanding opioid prescribing patterns for this at-risk population is essential to combat the opioid epidemic. A retrospective review of VHA Managerial Cost Accounting including the National Patient Care Database was queried to identify VHA Veterans with ‚â•1 MSKI diagnosis (n=4,455,335) from FY2013-2015. Opioid prescriptions (count) for these Veterans and associated information (medication, dose) were abstracted from the Treating Specialty and Outpatient National Data Extracts Database. Prescribed MMEs were calculated. VHA beneficiaries were stratified by age group. Rates and 95% confidence intervals (CI) were calculated for opioid prescriptions and MMEs per VHA beneficiary age group. Prescription and MME rates were compared between age groups; 95% CIs not overlapping with another age group were considered significantly different. VHA Veterans (n=4,455,335; males=90.9%) diagnosed with an MSKI during the study period were provided with 21,064,631 opioid prescriptions. Opioid prescription rates differed between all age groups (lowest-to-highest: <25 >[0.30 prescriptions/beneficiary; 95% CI: 0.29, 0.30], 95+, 85-94, 25-34, 75-84, 35-44, 65-74, 45-54, 55-64 [2.09 prescriptions/beneficiary; 95% CI: 2.09, 2.09]). MME rates per beneficiary differed between all age groups (lowest-to-highest: <25 >[5.35 MMEs/beneficiary; 95% CI: 5.34, 5.36], 95+, 84-94, 75-84, 25-34, 35-44, 65-74, 45-54, 55-64 [41.06 MMEs/beneficiary; 95% CI: 41.05, 41.06]). Veterans aged 45-74 receive the majority of opioid prescriptions amongst Veterans with MSKI within the VHA. These findings concur with previous studies. Individuals who receive >50 MME/day have greater risk for opioid overdose. None of the age groups exceeded this threshold; however, the 55-64 group was close. Our study identified a high risk sub-population (55-64 group) within an already at-risk population; this information can help clinicians be more cognizant when prescribing opioids and help mitigate the opioid epidemic.