While none of the veterans in the new analysis had previously reported misusing opioids, 1,416 of them had begun nonmedical use of opioid painkillers by 2012. Results also indicate that, of the 500 veterans in the study who began using heroin, 386 had also begun using prescription painkillers nonmedically.
That was the best predictor in the data of who ended up using heroin, according to study authors, who also pointed to other sociodemographic risk factors, such as being male (2.6-fold risk) or being black (2-fold risk). Abusing stimulant drugs, as opposed to not doing so, was associated with a 2.1-fold risk of using heroin, they added.
Interestingly, according to the study, receiving a short-term prescription for an opioid painkiller was associated with a less-than-1.7-fold risk of starting heroin, while a longer-term prescription was not significant at all as a risk factor..
“This paper shows that, as a general clinical practice, particularly for this population, which does experience a lot of chronic pain and other risks for substance use, including PTSD, screening for nonmedical painkiller use, whether you are prescribing an opioid or not, may be effective to prevent even more harmful transitions to heroin or other drugs,” Marshall said.
Meanwhile, the VA has responded to the risks created by rising opioid dependence among veterans. The agency’s facilities began implementing opioid overdose education and naloxone distribution (OEND) in 2013 and a national program began in 2014 – making it the first national healthcare system to implement such a program.
A recent study published in the journal Substance Abuse sought to determine patient perceptions of OEND training and naloxone kits.2
Results of focus groups indicated that OEND training was generally well received among study participants, including those with no indication for a naloxone kit. Patients described a need for OEND and believed it could save lives.
“Patient feedback on OEND training benefits, concerns, opinions, and suggestions provides important insights to inform future OEND training programs both within VA and in other healthcare settings,” conclude study authors from the VA Palo Alto, CA, Healthcare System. “Training is critical to maximizing the potential for OEND to save lives, and this study includes specific suggestions for improving the effectiveness and acceptability of training.
- Banerjee G, Edelman EJ, Barry DT, Becker WC, Cerdá M, Crystal S, Gaither JR,
Gordon AJ, Gordon KS, Kerns RD, Martins SS, Fiellin DA, Marshall BD. Non-medical
use of prescription opioids is associated with heroin initiation among US
veterans: a prospective cohort study. Addiction. 2016 Aug 23. doi:
10.1111/add.13491. [Epub ahead of print] PubMed PMID: 27552496.
- Oliva EM, Nevedal A, Lewis ET, McCaa MD, Cochran MF, Konicki PE, Davis CS,
Wilder C. Patient perspectives on an opioid overdose education and naloxone
distribution program in the U.S. Department of Veterans Affairs. Subst Abus.
2016;37(1):118-26. doi: 10.1080/08897077.2015.1129528. PubMed PMID: 26675643.
Research on fibromyalgia, a poorly understood, chronically disabling pain syndrome, generally has focused on its clinical presentation and treatment.
The VA is expanding remote management of patients to improve disease prevention and care.