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Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration.
- Source :
-
Alimentary pharmacology & therapeutics [Aliment Pharmacol Ther] 2018 Mar; Vol. 47 (6), pp. 784-791. Date of Electronic Publication: 2018 Jan 12. - Publication Year :
- 2018
-
Abstract
- Background: While opioid prescriptions have increased alarmingly in the United States (US), their use for unexplained chronic gastrointestinal (GI) pain (eg, irritable bowel syndrome) carries an especially high risk for adverse effects and questionable benefit.<br />Aim: To compare opioid use among US veterans with structural GI diagnoses (SGID) and those with unexplained GI symptoms or functional GI diagnoses (FGID), a group for whom opioids have no accepted role.<br />Methods: Veterans Health Administration (VHA) administrative data from fiscal year 2012 were used to identify veterans with diagnostic codes recorded for SGID and FGID. This cohort study examined VHA pharmacy data to compare groups receiving ≥ 1 opioid prescription during the year and number of prescriptions filled. Bivariate and multiple logistic regression analyses adjusted for potential confounding factors (demographics, medical diagnoses, social factors) and identified potential mediators (service use, psychiatric comorbidity) of opioid use in these groups.<br />Results: A greater proportion of veterans with FGID received an opioid prescription during fiscal year 2012 (36.0% of 272 431) compared to only 28.9% of 1 223 744 in the SGID group (Relative Risk [RR] = 1.25). In multivariate logistic regression, personality disorders and drug abuse (OR 1.23 for each group), recent homelessness (OR 1.22), psychotropic medication fills (OR 1.55) and emergency department encounters (OR 1.21) were independently associated with opioid prescription use.<br />Conclusions: Despite the potential for adverse consequences, opioids more often are prescribed for veterans with chronic, unexplained GI symptoms compared to those with structural diagnoses. Psychiatric comorbidities and frequent healthcare encounters mediate some of the opioid use risk.<br /> (© 2018 John Wiley & Sons Ltd.)
- Subjects :
- Abdominal Pain diagnosis
Abdominal Pain drug therapy
Abdominal Pain epidemiology
Adult
Aged
Aged, 80 and over
Cohort Studies
Comorbidity
Female
Humans
Male
Middle Aged
Practice Patterns, Physicians' statistics & numerical data
Psychotropic Drugs therapeutic use
United States epidemiology
United States Department of Veterans Affairs
Veterans Health
Analgesics, Opioid therapeutic use
Gastrointestinal Diseases diagnosis
Gastrointestinal Diseases drug therapy
Gastrointestinal Diseases epidemiology
Medically Unexplained Symptoms
Veterans statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1365-2036
- Volume :
- 47
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Alimentary pharmacology & therapeutics
- Publication Type :
- Academic Journal
- Accession number :
- 29327358
- Full Text :
- https://doi.org/10.1111/apt.14503