Veterans with PTSD more likely to be be prescribed painkillers

As veterans return from Iraq and Afghanistan, they continue to experience pain at home. And those who are diagnosed with mental health issues, including PTSD, are most likely to be prescribed opioid painkillers, according to a new study.

When surveying more than 140,000 veterans from Afghanistan and Iraq who had been diagnosed with some sort of pain, the study’s authors found that veterans with any mental health diagnosis, including depression, anxiety disorders, or drug and alcohol abuse, were 2.4 more times likely to be prescribed opioid painkillers, like oxycodone and hydrocodone, than veterans without any mental health diagnosis.

When looking at veterans diagnosed with PTSD, in particular, that rate was even higher. 17% of those with PTSD were prescribed opioids compared to just 6.5% of veterans without any mental health diagnosis.

The study, published in the Journal of the American Medical Association and conducted by Dr. Karen Seal of the San Francisco Veteran's Administration Medical Center and her co-authors, is the first national-level study of veterans from Iraq and Afghanistan to look at correlations between mental diagnosis and pain treatment.

“Nearly half of all Veterans returning to this country and presenting for care at the VA had pain problems. A percentage of these patients also suffer from mental health problems of the invisible injuries of war such as depression but in more cases, PTSD,” says Seal.

Since the mid-1990s there has been an increasing awareness of how to treat pain. In 2000, the VA adopted the idea of “pain as the 5th vital sign.” Because of the increased awareness of pain treatment, the prescription of opioids has nearly doubled, nationally, since 1994.

However, with increased use of opioids, there is also an increasing rate of misuse and overdose. According to the CDC, every 19 minutes, someone dies from an unintentional drug overdose and opioids are the most commonly associated drugs involved in these deaths. Prescription drugs are involved in more overdose deaths than heroin and cocaine combined, according to the CDC.

The study followed the veterans over the course of a year, to determine their opioid use. The authors found veterans with PTSD, were also at highest risk for self-inflicted injuries and alcohol-related, drug-related, and opioid-related accidents and overdoses.

“These patients tend to receive higher dose opiates than their counterparts and would request early refills of their opiates which indicates that they are using them more quickly than they should be,” says Seal.

In addition, veterans with PTSD were the most likely to be prescribed more than one opioid, as well as benzodiazepines. Another point of concern, because the combination of these two families of drugs, can lead to an overdose.

The authors emphasized that the study didn’t find that PTSD or other mental health diagnosis caused increased pain or opioid use. Rather, the study was an alarm to the consequences of pain management through opioids.

“We now need to start considering alternative solutions to relieving our patient’s pain and suffering,” Seal noted.