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Narcotic Painkillers Another Threat to Traumatized War Vets: Study
Date:3/7/2012

By Steven Reinberg
HealthDay Reporter

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 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.

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

More information

For more information on PTSD, visit the U.S. National Institute of Mental Health.

SOURCES: Karen H. Seal, M.D., M.P.H., San Francisco Veterans Affairs Medical Center; Jennifer J. Vasterling, Ph.D., chief, psychology, VA Boston Healthcare System, and professor, psychiatry, Boston University School of Medicine; Simon A. Rego, Psy.D., director, psychology training, Montefiore Medical Center, New York City; March 6, 2012, news release, U.S. Department of Veterans Affairs; March 7, 2012, Journal of the American Medical Association


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