Low Opioid Use in Veterans With Recent Traumatic Brain Injury

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Veterans diagnosed with TBI don't use opioids very often.

Opioid use was shown to be relatively low in veterans of Iraq and Afghanistan who have recently diagnosed traumatic brain injuries, but approximately one-quarter of those who initiated opioids were chronic users, according to a recent study published in Pain Medicine.

In this retrospective study of Veterans Health Administration (VHA) databases, 35,621 Iraq or Afghanistan veterans with recent traumatic brain injury diagnoses were evaluated for opioid use after diagnosis.

Exclusion criteria included receipt of a VHA opioid prescription within the year preceding diagnosis, visiting the VHA less than twice during the study period, and ≤1 year of VHA data after diagnosis.

Of the veterans with recent traumatic brain injuries, 21% initiated opioids within a year of diagnosis (mean morphine equivalent dose, 24.0 mg daily; mean days supplied, 60.52). A total of 23% of patients who initiated opioids during the study were chronic opioid users.

Risk factors for opioid initiation included age of 36 to 45 years (odds ratio [OR], 1.09; P =.04), female sex (OR, 1.22; P <.001), back pain (OR, 1.38; P <.001), arthritis/joint pain (OR, 1.24; P <.001), or neuropathic pain (OR, 1.415; P <.019).

Living in small rural areas (OR, 1.31; P < .0001) and back pain (OR, 1.33; P =.006) were associated with chronic opioid use in patients between the ages of 36 and 45 years. Headache and migraine pain were associated with a decreased risk for chronic opioid use (OR, 0.639; P =.0026).

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The study authors concluded that “future analyses should seek to better understand factors that influence outcomes of [traumatic brain injury] and opioid use in this cohort, including longer observation periods to examine the trajectory of opioid use and gender-related differences in chronic use among opioid initiators.”


Hudson TJ, Painter JT, Gressler LE, et al. Factors associated with opioid initiation in OEF/OIF/OND veterans with traumatic brain injury [published online September 26, 2017]. Pain Medicine. doi: 10.1093/pm/pnx208

This article originally appeared on Clinical Pain Advisor