Narcotic Painkillers Another Threat to Traumatized War Vets: Study


Iraq and Afghanistan war  veterans who have psychiatric disorders, especially post-traumatic stress  disorder, are more likely than mentally healthy vets to use prescription narcotic painkillers, a new study finds.

Use of these opioid pain medications, such as OxyContin, Percocet and  Vicodin, can become addictive and cause more serious problems, researchers  say.

“Veterans using these narcotic painkillers had worse clinical  outcomes,” said lead researcher Dr. Karen Seal, from the San Francisco  Veterans Affairs Medical Center. “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 [post-traumatic  stress disorder],” Seal explained.

In the study of pain patients, those with PTSD, an illness marked by  disabling anxiety, were more than twice as likely to receive opioid  painkillers as those without mental health problems. Seal said these  veterans are more likely to look for pain relief than seek mental health  treatment.

“We are trying to change that situation,” Seal said. Primary care  physicians should screen patients for mental and drug or alcohol abuse  problems and first offer alternatives to opioid pain medications, such as  referral for mental health or pain care, she noted.

The report was published in the March 7 issue of the Journal of the  American Medical Association.

For the study, Seal’s team looked at the association between mental  health problems and unfavorable results — including accidents, overdose  and self-inflicted injury — with use of prescription painkillers in more  than 140,000 veterans treated for pain at VA hospitals from October 2005  to December 2010.

Almost 16,000 patients received prescriptions for painkillers covering  20 or more days, the researchers found.

About 18 percent of veterans with PTSD and almost 12 percent with other  mental health problems, such as  depression and anxiety, received narcotic  painkiller prescriptions compared with less than 7 percent of those  without mental health problems, the results showed.

Vets with PTSD were more likely to take higher doses and more than one  painkiller than mentally healthy vets. They were also more likely than the  others to take sedatives and to refill their prescriptions early, the  researchers noted.

“This indicates to us that they may be using their pain medication  faster than prescribed and be self-medicating,” Seal said.

Also, veterans with PTSD who also abused drugs were much more likely to  be prescribed narcotic painkillers than those without mental health  problems, the study found.

Jennifer Vasterling, chief of psychology at the VA Boston Healthcare  System and professor of psychiatry at Boston University School of  Medicine, said that this study highlights the potent combination of PTSD  and pain.

“The paper reinforces that the detrimental effects of war-zone trauma  and PTSD are far-reaching, extending beyond emotional symptoms to  negatively impact other aspects of health and functioning,” Vasterling  said.

The poor results associated with increased prescription painkiller use  have “significant implications for the clinical management of pain in  military veterans with PTSD and pain,” Vasterling added.

Another expert, Simon Rego, director of psychology training at  Montefiore Medical Center in New York City, said the study findings are  troubling. “Veterans with PTSD are also known to have high rates of  substance use disorders, and treatment with opioids among patients with  mental health problems is thought to exacerbate substance abuse and worsen  mental health problems over time,” he said.

It’s possible that veterans with mental health problems, particularly  PTSD, find barriers to mental health treatment and often use VA primary  care, where doctors may lack specialized training in the management of  pain and PTSD, he said.

“Clearly, further efforts are required to improve the care of these  patients with pain and PTSD, and extra care should be taken when  prescribing opioids to relieve their distress,” Rego said.

The Department of Veterans Affairs, acknowledging concerns about  prescription drug abuse, said in a statement Tuesday that it welcomes this  study. “While this research acknowledges that VA is a leader in providing  therapy for PTSD and pain, we recognize that more work remains,” the  statement said.

T hat work includes teaming up primary care physicians with nurses,  mental health providers, pharmacists and social workers, the VA said.

By By Steven Reinberg



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