In:
Journal of Head Trauma Rehabilitation, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 3 ( 2020-05), p. 209-217
Abstract:
To evaluate the association between traumatic brain injury (TBI) and nonfatal opioid overdose, and the role of psychiatric conditions as mediators of this association. Setting: Post-9/11 veterans receiving care at national Department of Veterans Affairs (VA) facilities from 2007 to 2012. Participants: In total, 49 014 veterans aged 18 to 40 years receiving long-term opioid treatment of chronic noncancer pain. Design: Longitudinal cohort study using VA registry data. Main Measures: TBI was defined as a confirmed diagnosis (28%) according to VA comprehensive TBI evaluation; no TBI was defined as a negative primary VA TBI screen (ie, no head injury). Nonfatal opioid overdose was defined using ICD-9 ( International Classification of Diseases, Ninth Revision ) codes. We performed demographic-adjusted Cox proportional hazards regression. We quantified the impact of co-occurring and individual psychiatric conditions (mood, anxiety, substance use, and posttraumatic stress disorder) on this association using mediation analyses. Results: Veterans with TBI had more than a 3-fold increased risk of opioid overdose compared with those without (adjusted hazards ratio [aHR] = 3.22; 95% confidence interval [CI] , 2.13-4.89). This association was attenuated in mediation analyses of any co-occurring psychiatric condition (aHR = 1.77; 95% CI, 1.25-2.52) and individual conditions (aHR range, 1.52-2.95). Conclusion: TBI status, especially in the context of comorbid conditions, should be considered in clinical decisions regarding long-term use of opioids in patients with chronic pain.
Type of Medium:
Online Resource
ISSN:
0885-9701
DOI:
10.1097/HTR.0000000000000546
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2020
detail.hit.zdb_id:
2053481-4
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