Veterans returning from Iraq and Afghanistan who are suffering from post-traumatic stress disorder (PTSD) are more likely to be prescribed potentially addictive opiod painkillers such as oxycodone, morphine and hydrocodone, according to a study published Tuesday in the Journal of the American Medical Association.
The study, led by Dr. Karen Seal of the San Francisco Veteran's Administration Medical Center, followed more than 140,000 veterans of the wars in Iraq and Afghanistan and found that 6.5 percent of those without mental health issues received prescriptions for opiods. But among veterans with PTSD, that number rose to 17.8 percent. Meanwhile, 11.7 percent of veterans with other mental health disorders depression were also prescribed the painkillers.
The study also found that veterans with PTSD were almost more likely to be prescribed higher doses of pain medications, or to receive two or more opiods concurrently, to take the drugs for longer periods of time, or to also receive prescriptions for sedative hypnotics.
Even more troubling, the study found that veterans with PTSD who received these drugs were more likely to experience drug or alcohol overdoses, purposefully injure themselves, or commit suicide.
As Seal and her co-authors write in the paper, the prescription use of opiods in America has nearly doubled since 1994. "At the same time, rates of prescription opioid misuse and overdose have increased sharply, and prescription opioids are now a leading cause of death in the United States. Iraq and Afghanistan veterans with pain- and PTSD-prescribed opioids may be at particularly high risk of prescription opioid misuse given the high co-occurrence of substance abuse disorders among veterans with PTSD."
In discussing the use of painkillers for veterans, Seal told Reuters "There's really been a culture of, 'Let's get rid of pain,' and I think unfortunately that pendulum may have swung too far. What we need to do now is really individually assess patients and talk to patients about what we know of the risks of opiates, especially in those with mental health problems."
Seal also said that talk therapy, physical therapy and anti-inflammatory painkillers such as ibuprofen often help patients with both pain and mental health issues as well as if not better than opiods.
"One of the things that we're trying to do is, if it appears that there may be a risk for unsafe use of opioids, to really bring that up honestly with the patients, and suggest that there may be other alternatives," she told Reuters.
Michael Von Korff, a chronic illness researcher with Group Health Research Institute in Seattle, who was not affiliated with the study, told the Associated Press than many doctors may be prescribing opiods "with the hope that the emotional distress that accompanies chronic pain will also be reduced." He said they may actually end up causing emotional issues to worsen.
The Department of Veterans Affairs paid for the study. In a statement to the media, the VA called its approach to pain management a "model of care" but acknowledged that "more work needs to be done."
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