Prevalence and Trends of Concurrent Opioid Analgesic and Benzodiazepine Use Among Veterans Affairs Patients with Post‐traumatic Stress Disorder, 2003–2011

Background Patients with post‐traumatic stress disorder (PTSD) have complex and multiple symptoms, including anxiety, insomnia, and co‐occurring pain, often treated with opioids and benzodiazepines. While concurrent use of these medications poses safety concerns, little is known about the trends of long‐term concurrent use and the prevalence of high‐risk conditions among those who are prescribed them. Study objectives were to examine the trends in annual prevalence of long‐term concurrent opioid and benzodiazepine use among patients with PTSD and prevalence of high‐risk conditions in concurrent users of these medications. Design Retrospective review of pharmacy records of the Veteran Affairs Northwest Integrated Network (VISN20). Subjects Patients (n = 66,210) with PTSD receiving care during 2003–2011. Methods Concurrent use was defined as overlapping opioid and benzodiazepine prescriptions for ≥90 consecutive days. Gender‐specific logistic regressions estimated long‐term concurrent use of these medications and tested for linear trends over 9‐years. Results The trend in age‐adjusted long‐term concurrent opioid and benzodiazepine use over 9‐years increased 52.7%, from 3.6% (95% confidence interval, 3.3–3.9%) to 5.5% (5.3–5.8%), in men and 79.5%, from 3.9% (3.0–5.0%) to 7.0% (6.2–7.9%), in women. In 2011, 17.1% of long‐term concurrent users were prescribed morphine‐equivalent daily doses of opioids ≥100 mg and 49.4% had a documented high‐risk condition. Conclusion Despite known risks associated with prescribing opioids and benzodiazepines concurrently, the adjusted prevalence of long‐term concurrent use rose significantly among men and women with PTSD in VISN20 over a 9‐year period. Common use of these medications among patients with high‐risk conditions suggests comprehensive strategies are needed to identify and monitor patients at increased risk for adverse outcomes.