Opioid dosing trends over eight years among US Veterans with musculoskeletal disorders after returning from service in support of recent conflicts

Ling Han, Heather Allore, Joseph Goulet, Harini Bathulapali, Melissa Skanderson, Cynthia Brandt, Sally Haskell, Erin E Krebs

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Purpose To examine long-term opioid dosing trends among Veterans with chronic pain. Methods We identified 79,015 Veterans with musculoskeletal disorders who were dispensed greater than or equal to 1 opioid prescriptions between 2002 and 2009 after returning from recent conflicts. Opioid-dosing trends were examined using a generalized estimating equation while accounting for patient characteristics, temporal and geographic confounding. Results In total, 472,819 opioid prescriptions were dispensed (mean ± standard deviation: 6.0 ± 10.1 per Veteran). Both average daily morphine equivalents (MEs/d) and the proportion of high-dose prescribing (greater than 100 ME/d) increased from baseline period (2002–2004) to 2006, then remained relatively stable. Veterans with extended persistent (greater than or equal to 40 days over 1–2 episodes) and extended intermittent (greater than or equal to 40 days over greater than or equal to three episodes) dispensing patterns received more high-dose prescriptions than those dispensed prescriptions less than 40 days, with adjusted odds ratios (95% confidence interval) of 7.2 (6.0–8.8) and 3.6 (3.0–4.3), respectively. Posttraumatic stress disorder and other mental health diagnoses were associated with 30% increased odds of high-dose prescribing. Conclusions The average daily dose of opioid prescriptions and the likelihood of high-dose prescribing to these Veterans appeared to increase from 2002 to 2006, then remained relatively stable through 2009. Veterans on opioid prescriptions for extended duration or with mental health diagnoses tend to receive higher dose therapy.

Original languageEnglish (US)
Pages (from-to)563-569.e3
JournalAnnals of epidemiology
Issue number9
StatePublished - Sep 2017

Bibliographical note

Funding Information:
This work was funded by VA HSR&D Women Veterans Cohort Study (Brandt, Haskell, Goulet, Krebs, Han), VA HSR&D Musculoskeletal Diagnoses Cohort: Examining Pain and Pain Care in the VA (CRE 12-012; Goulet, Brandt), and NIH/NCCIH grant (R01 AT008448; Brandt, Han, Goulet) and supported in part by the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine (#P30AG021342 NIH/NIA; Han, Allore). The opinions expressed here are those of the authors and do not represent the official policy or position of the US Department of Veterans Affairs. Appendix

Publisher Copyright:
© 2017 Elsevier Inc.

Copyright 2017 Elsevier B.V., All rights reserved.


  • Dispensing pattern
  • Dynamic cohort
  • Electronic pharmacy records
  • Mental health diagnoses
  • Musculoskeletal pain
  • Opioid-dosing trends
  • Veterans

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