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Patterns and Correlates of Prescription Opioid Receipt Among US Veterans: A National, 18-Year Observational Cohort Study

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Abstract

A better understanding of predisposition to transition to high-dose, long-term opioid therapy after initial opioid receipt could facilitate efforts to prevent opioid use disorder (OUD). We extracted data on 69,268 patients in the Veterans Aging Cohort Study who received any opioid prescription between 1998 and 2015. Using latent growth mixture modelling, we identified four distinguishable dose trajectories: low (53%), moderate (29%), escalating (13%), and rapidly escalating (5%). Compared to low dose trajectory, those in the rapidly escalating dose trajectory were proportionately more European-American (59% rapidly escalating vs. 38% low); had a higher prevalence of HIV (31% vs. 29%) and hepatitis C (18% vs. 12%); and during follow-up, had a higher incidence of OUD diagnoses (13% vs. 3%); were hospitalised more often [18.1/100 person-years (PYs) vs. 12.5/100 PY]; and had higher all-cause mortality (4.7/100 PY vs. 1.8/100 PY, all p < 0.0001). These measures can potentially be used in future prevention research, including genetic discovery.

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Acknowledgements

This work was supported by US National Institutes of Health, including Grants from National Institute on Alcohol Abuse and Alcoholism (U24-AA020794, U01-AA020790, U10-AA013566-completed to ACJ) and National Institute on Drug Abuse (NIDA R01-DA040471, R01-DA12690). Additional support was provided by the US Department of Veterans Affairs (i01-BX003341), Yale School of Medicine Drug Use, Addiction, and HIV Research Scholars Program (DAHRS K12-DA033312), and Agency for Healthcare Research and Quality (AHRQ U19-HS021112 and R18-HS023258). The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The views presented in this paper are the authors’ and not necessarily those of the Department of Veterans Affairs or the United States Government.

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Authors and Affiliations

  1. Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

    Christopher T. Rentsch

  2. Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, 06516, USA

    Christopher T. Rentsch, Amy C. Justice & Janet P. Tate

  3. Internal Medicine, Yale School of Medicine, New Haven, CT, 06515, USA

    E. Jennifer Edelman, Amy C. Justice, David A. Fiellin, Janet P. Tate & William C. Becker

  4. Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06515, USA

    E. Jennifer Edelman, Amy C. Justice & David A. Fiellin

  5. Department of Epidemiology, Brown School of Public Health, Providence, RI, 02903, USA

    Brandon D. L. Marshall

  6. Department of Psychiatry, Yale School of Medicine and VA Connecticut Healthcare System, West Haven, CT, 06516, USA

    Ke Xu, Andrew H. Smith, Renato Polimanti & Joel Gelernter

  7. Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, 08901, USA

    Stephen Crystal

  8. Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, 06515, USA

    Julie R. Gaither

  9. Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, 06516, USA

    Julie R. Gaither & William C. Becker

  10. VA COIN Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City VA Health Care System, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA

    Adam J. Gordon

  11. School of Nursing, University of Louisville, Louisville, KY, 40202, USA

    Rachel V. Smith

  12. Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA

    Rachel L. Kember

  13. Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA

    Rachel L. Kember & Henry R. Kranzler

  14. Departments of Genetics and Neuroscience, Yale School of Medicine, New Haven, CT, 06515, USA

    Joel Gelernter

  15. Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA

    Henry R. Kranzler

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  1. Christopher T. Rentsch
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  2. E. Jennifer Edelman
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Correspondence to Christopher T. Rentsch.

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Conflict of interest

Dr. Kranzler is a Member of the American Society of Clinical Psychopharmacology’s Alcohol Clinical Trials Initiative, which was supported in the last 3 years by AbbVie, Alkermes, Ethypharm, Indivior, Lilly, Lundbeck, Otsuka, Pfizer, and XenoPort. Drs. Kranzler, Gelernter, and A. Smith are also named as Inventors on PCT Patent Application #15/878,640 entitled: “Genotype-guided dosing of opioid agonists,” filed January 24, 2018. The remaining authors have no conflicts of interest.

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Rentsch, C.T., Edelman, E.J., Justice, A.C. et al. Patterns and Correlates of Prescription Opioid Receipt Among US Veterans: A National, 18-Year Observational Cohort Study. AIDS Behav 23, 3340–3349 (2019). https://doi.org/10.1007/s10461-019-02608-3

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