• Jennifer R Fonda, Jaimie L Gradus, Susan B Brogly, Regina E McGlinchey, William P Milberg, and Lisa Fredman.
• Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts (Drs Fonda, McGlinchey, and Milberg); Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts (Drs Fonda and Gradus); Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts (Drs Gradus, Brogly, and Fredman); Department of Surgery, Queens University, Kingston, Ontario, Canada (Dr Brogly); and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (Drs McGlinchey and Milberg).
• J Head Trauma Rehabil. 2020 May 1; 35 (3): 209-217.

ObjectiveTo evaluate the association between traumatic brain injury (TBI) and nonfatal opioid overdose, and the role of psychiatric conditions as mediators of this association.SettingPost-9/11 veterans receiving care at national Department of Veterans Affairs (VA) facilities from 2007 to 2012.ParticipantsIn total, 49 014 veterans aged 18 to 40 years receiving long-term opioid treatment of chronic noncancer pain.DesignLongitudinal cohort study using VA registry data.Main MeasuresTBI 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.ResultsVeterans 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).ConclusionTBI 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.

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