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Veterans With PTSD at Increased Risk for Receiving, Abusing Opioids, Study Finds
FPs Can Play Key Role in Treating These Patients
By Matt Brown
According to the study authors, returning combat veterans likely will be visiting primary care physicians in large numbers, and extra care should be taken when prescribing opioids to relieve physical symptoms.
"These patients may benefit from biopsychosocial models of pain care, including evidence-based nonpharmacologic therapies and nonopioid analgesics," the authors wrote. "Integrated treatments that target both mental health disorders and pain simultaneously are effective for both problems and may decrease harms resulting from opioid therapy."
The study also noted that the association between PTSD and opioid prescription -- which it found to be especially robust -- proved to be significant for all subgroups of veterans with PTSD.
- A study in JAMA: the Journal of the American Medical Association, indicates soldiers returning from Iraq and Afghanistan who have mental health diagnoses, especially those with posttraumatic stress disorder (PTSD), are at an "increased risk of receiving opioids for pain, high-risk opioid use and adverse clinical outcomes."
- With returning combat veterans presenting to primary care physicians in large numbers, extra care should be taken when prescribing opioids to relieve physical symptoms.
- According to one FP expert, however, when opioid therapy is administered to service members shortly after acute injury during combat, it can actually reduce their risk of developing PTSD.
According to FP Jeffrey Sonis, M.D., M.P.H., of Chapel Hill, N.C., family physicians are in a unique position to help these veterans.
"From the article, I think it is reasonable to draw the conclusion that primary care docs should be careful about prescribing opiates to returning service members with PTSD, since they are more likely to demonstrate high-risk use of opiates -- such as using higher doses, obtaining early refills and receiving concurrent sleeping medications -- and more likely to have adverse outcomes, such as opioid-related injuries and alcohol and drug overdoses," said Sonis.
The study authors said their findings support improving care of patients with comorbid pain and PTSD because of the heightened risk of self-medication with opioids and substance abuse in veterans with PTSD, which may result in further declines in interpersonal and occupational functioning.
"Trials assessing the efficacy of opioids in treating chronic noncancer pain have shown only modest or equivocal benefit," the authors wrote. "In contrast, multiple studies have described numerous harms, including overdose death, from the upsurge of opioid prescribing in recent years."
Still, said Sonis, who designed a free, AAFP-approved, online CME course for FPs on treating PTSD, opioids do have a place in treating some of these patients.
"Indeed, there is evidence from other studies that opiates, given shortly after acute injury, reduce the risk of PTSD among service members injured during combat," he told AAFP News Now.
FPs with questions about treating veterans with PTSD can access the Academy's Joining Forces Web page to learn more about the issue.