• Pain Med · Jul 2014

    Increased polysedative use in veterans with posttraumatic stress disorder.

    • Nancy C Bernardy, Brian C Lund, Bruce Alexander, and Matthew J Friedman.
    • National Center for PTSD, Veterans Affairs Medical Center, White River Junction, VT, USA; Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
    • Pain Med. 2014 Jul 1; 15 (7): 1083-90.

    BackgroundPosttraumatic stress disorder (PTSD) treatment is often complicated in veterans by co-occurring conditions including pain, insomnia, brain injury, and other mental disorders. Pharmacologic approaches to these conditions can produce an accumulation of sedating medications with potential for safety concerns.ObjectiveThe objective of this study was to characterize polysedative prescribing among veterans with PTSD over an 8-year period.DesignNational Department of Veterans Affairs (VA) data were used to identify veterans with PTSD using International Classification of Diseases, Ninth Revision codes among regular medication users. Prescribing of benzodiazepines, hypnotics, atypical antipsychotics, opioids, and muscle relaxants was determined annually. Prevalence and incidence rates were determined for each medication class from 2004 through 2011. Polysedative use was determined from longitudinal refill patterns that indicated concurrent use across sedative classes.ResultsIn 2004, 9.8% of veterans with PTSD concurrently received medications from three or more sedative classes. By 2011, the prevalence of concurrent use involving three or more classes increased to 12.1%. Polysedative use varied across demographic subgroups, with higher rates observed among women, rural residents, younger adults, Native Americans and Whites. The most common combination was an opioid plus a benzodiazepine, taken concurrently by 15.9% of veterans with PTSD.ConclusionsImportant trends in polysedative use among veterans with PTSD illustrate the complexity of treating an intersecting cluster of symptoms managed by sedative medications. As the VA seeks to improve care by focusing on non-pharmacologic options, our findings emphasize the need for a comprehensive approach that encompasses overlapping conditions of relevance to veterans with PTSD.Wiley Periodicals, Inc.

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