Narcotic Painkillers Another Threat to Traumatized War
TUESDAY, March 6 (HealthDay News) -- 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
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,"
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
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.
That work includes teaming up primary care physicians with
nurses, mental health providers, pharmacists and social workers,
the VA said.
For more information on PTSD, visit the
U.S. National Institute of Mental Health.
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