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Wednesday, March 7, 2012

Opioids and Mental Illness

There is no doubt that combat changes people mentally and physically. A number of soldiers who come back from foreign battles experience post-traumatic stress, depression, and anxiety. Hopefully those individuals receive the treatment they require and don’t have to resort to self-medicating in order to cope. Unfortunately, some veterans are being treated with drugs that make treating psychiatric problems much more difficult.

A study was conducted which found that U.S. veterans coming home from Iraq and Afghanistan who have post-traumatic stress disorder (PTSD) and other psychiatric disorders are twice as likely receive prescription opioids for pain than those who don’t.

“Veterans using these narcotic painkillers had worse clinical outcomes,” lead researcher Dr. Karen Seal of the San Francisco Veterans Affairs Medical Center told HealthDay. “Those outcomes were wounds and injuries, alcohol and drug overdoses, opioid overdoses, violent injuries and even suicide. This was particularly true in the group with PTSD.”

141,029 veterans who received at least one non-cancer-related pain diagnosis within a year of entering the Department of Veterans Affairs health care system were included in the study. A total of 15,676 veterans were prescribed opioids within one year of their initial pain diagnosis.
  • 17.8 percent of veterans with PTSD received opioids for pain.
  • 11.7 percent of veterans with other mental health diagnoses received opioids for pain.
Compared to:
  • 6.5 percent of veterans without mental health disorders received opioids for pain.

Of those who were prescribed pain medication, 22.7 percent of veterans with PTSD received higher-dose opioids, compared with 15.9 percent of those without mental health disorders. Veterans with PTSD were also more likely to receive two or more opioids together, as well as obtain early opioid refills.

“Returning combat veterans are presenting to primary care in large numbers and are seeking relief from physical and psychological pain. Extra care should be taken when prescribing opioids to relieve their distress,” the researchers note in a news release.

“Integrated treatments that target both mental health disorders and pain simultaneously are effective for both problems and may decrease harms resulting from opioid therapy.”

The results appear in the Journal of the American Medical Association.

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