ArticleDrug and alcohol dependence reports2025
Substance use and use disorders among Veterans on long-term opioid therapy.
Article in Drug and alcohol dependence reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Few studies have reported on the prevalence and health risks associated with substance use and substance use disorder (SU/SUD) in Veterans who use long-term opioid therapy (LTOT). We leveraged health record data to estimate SU/SUD prevalence and its association with mortality among Veterans on LTOT. Methods: We conducted a secondary analysis of cohort data for Veterans on LTOT within Veterans Health Administration outpatient settings (2014-2019). SU/SUD was defined as a positive screen for risky alcohol use; a positive urine drug screen for cannabis, benzodiazepines, or stimulants; or a documented SUD diagnosis. We fit Cox models for all-cause mortality, fatal overdose, and traumatic deaths, comparing Veterans on LTOT with SU/SUD vs. LTOT-only. Results: One in four (25.0 %) Veterans on LTOT have risky alcohol use, tested positive for other substances, or had a diagnosed SUD. Alcohol was the most common SU/SUD (9.8 %), followed by sedative (8.1 %), cannabis (6.6 %), and stimulant (0.6 %). Relative to Veterans on LTOT only, mortality rates were higher for Veterans on LTOT with cannabis (HR=1.16, 95 % CI=1.03, 1.30), sedative (HR=1.29, 95 % CI=1.10, 1.52), or stimulant SU/SUD (HR=1.54, 95 % CI=1.17, 2.02). Fatal overdose rates were higher for LTOT with alcohol (HR=1.43, 95 % CI=1.10, 1.86), sedatives (HR=1.40, 95 % CI=1.04, 1.91), or stimulant SU/SUD (HR=3.29, 95 % CI=1.60, 6.77). LTOT with sedative SU/SUD was associated with traumatic death rates (HR=1.30, 95 % CI=1.05, 1.61). Conclusion: Substance co-use is common among Veterans on LTOT and is associated with elevated mortality and overdose risks. Comprehensive screening and targeted interventions may be needed.
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