• Eric J Hawkins, Carol A Malte, Joel R Grossbard, and Andrew J Saxon.
• Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, USA.
• Pain Med. 2015 Oct 1; 16 (10): 1943-54.

BackgroundPatients with post-traumatic stress disorder (PTSD) have complex and multiple symptoms, including anxiety, insomnia, and co-occurring pain, often treated with opioids and benzodiazepines. While concurrent use of these medications poses safety concerns, little is known about the trends of long-term concurrent use and the prevalence of high-risk conditions among those who are prescribed them. Study objectives were to examine the trends in annual prevalence of long-term concurrent opioid and benzodiazepine use among patients with PTSD and prevalence of high-risk conditions in concurrent users of these medications.DesignRetrospective review of pharmacy records of the Veteran Affairs Northwest Integrated Network (VISN20).SubjectsPatients (n = 66,210) with PTSD receiving care during 2003-2011.MethodsConcurrent use was defined as overlapping opioid and benzodiazepine prescriptions for ≥90 consecutive days. Gender-specific logistic regressions estimated long-term concurrent use of these medications and tested for linear trends over 9-years.ResultsThe trend in age-adjusted long-term concurrent opioid and benzodiazepine use over 9-years increased 52.7%, from 3.6% (95% confidence interval, 3.3-3.9%) to 5.5% (5.3-5.8%), in men and 79.5%, from 3.9% (3.0-5.0%) to 7.0% (6.2-7.9%), in women. In 2011, 17.1% of long-term concurrent users were prescribed morphine-equivalent daily doses of opioids ≥100 mg and 49.4% had a documented high-risk condition.ConclusionDespite known risks associated with prescribing opioids and benzodiazepines concurrently, the adjusted prevalence of long-term concurrent use rose significantly among men and women with PTSD in VISN20 over a 9-year period. Common use of these medications among patients with high-risk conditions suggests comprehensive strategies are needed to identify and monitor patients at increased risk for adverse outcomes.Wiley Periodicals, Inc.

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