Research Paper Title

Predictors of Postdeployment Prescription Opioid Receipt and Long-term Prescription Opioid Utilization Among Army Active Duty Soldiers.

Background

Little is known about long-term prescription opioid utilisation in the Military Health System. The objectives of this study were to examine predictors of any prescription opioid receipt, and predictors of long-term opioid utilisation among active duty soldiers in the year following deployment.

Methods

The analytic sample consisted of Army active duty soldiers returning from deployment to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn in fiscal years 2008-2014 (N = 540,738). The Heckman probit procedure was used to jointly examine predictors of any opioid prescription receipt and long-term opioid utilisation (i.e., an episode of 90 days or longer where days-supply covered at least two-thirds of days) in the post-deployment year. Predictors were based on diagnoses and characteristics of opioid prescriptions.

Results

More than one-third of soldiers (34.8%, n = 188,211) had opioid receipt, and among those soldiers, 3.3% had long-term opioid utilisation (or 1.1% of the cohort, n = 6,188). The largest magnitude predictors of long-term opioid utilisation were receiving a long-acting opioid within the first 30 days of the episode, diagnoses of chronic pain (no specified source), back/neck pain, or peripheral/central nervous system pain, and severe pain score in vital records.

Conclusions

Soldiers returning from deployment were more likely to receive an opioid prescription than the overall active duty population, and 1.1% initiated a long-term opioid episode. The researchers report a declining rate of opioid receipt and long-term opioid utilisation among Army members from fiscal years 2008-2014. This study demonstrates that the most important predictors of opioid receipt were not demographic factors, but generally clinical indicators of acute pain or physical trauma.

Reference

Adams, R.S., Thomas, C.P., Ritter, G.A., Lee, S., Saadoun, M., Williams, T.V. & Larson, M.J. (2018) Predictors of Postdeployment Prescription Opioid Receipt and Long-term Prescription Opioid Utilization Among Army Active Duty Soldiers. Military Medicine. doi: 10.1093/milmed/usy162. [Epub ahead of print].