UTILIZATION OF PRESCRIPTION MEDICATIONS AND MEDICATIONS LABELLED FOR SUICIDE RISK AMONG VETERANS WITH POST-TRAUMATIC STRESS DISORDER, BIPOLAR AFFECTIVE DISORDER, MAJOR AFFECTIVE DISORDER AND/OR SCHIZOPHRENIA IN A PRAGMATIC RANDOMIZED TRIAL

OBJECTIVES: To describe the prescription drug utilization of 243 Veterans with post-traumatic stress disorder, schizophrenia, bipolar disorder or major affective disorder who both enrolled and completed at least 2 assessments for a pragmatic randomized trial of blister packaging versus dispensing as usual of all prescribed medications in Denver, Colorado between 2012 and 2014. The intervention was designed to improve adherence and reduce suicide risk. METHODS: Trial records were linked to VHA Corporate Data Warehouse (CDW) prescription fill records for the study period by unique patient ID. This study was reviewed and approved by the VISNs 2 and 19 Human Subjects Review Boards and the Department of Defense Human Research Protections Office. RESULTS: 236 (97.1%) of these Veterans filled at least one prescription for a tablet or capsule drug product at the VA outpatient pharmacy while enrolled in the study. Subjects were enrolled for a mean of 9.4 months during which time they filled a total of 5,939 tablet and capsule prescriptions. The most prevalent drug classes were antidepressants (CN609) (17%) and anticonvulsants (CN400) (12%). The most frequent drug products dispensed were trazodone (6%), sertraline (5%), prazosin (5%), omeprazole (4%), and gabapentin (4%). CONCLUSIONS: This pragmatic randomized trial was designed to improve medication adherence among Veterans who may be at elevated risk of suicide or overdose due to schizophrenia or bipolar disorder, for example. Both are associated with increased risk of suicide. The most prevalenet prescription medications in this pragmatic trial were antidepressants and anticonvulsants, all of which are labelled for risk of suicidal ideation and behavior. Further examination of combination prescribing refinement of warning labels for suicide risk may support future adherence and prevention efforts. LIMITATIONS: Prescription fills outside of VA were not observed.