The overarching goal of this dissertation was to understand the extent of opioid use among persons with traumatic brain injury (TBI) and inform health policy related to these medications. Both the population of persons with TBI and the integrated structure of care in the Veterans Health Administration (VHA) makes VHA data particularly relevant to this purpose and was therefore used for all analyses. The goals were accomplished through three sets of analyses organized into three chapters. Chapter 2 found that opioid use among Iraq and Afghanistan Veterans in general is lower than Veterans as a whole and that while TBI was not a risk factor for receiving opioids among this group, when opioids were used, they were used more aggressively. Chapter 3 found that, in a cohort of Iraq and Afghanistan Veterans with TBI, approximately 20% initiated opioids in the 365 after diagnoses and about 25% of initiators used opioids chronically. Women appeared more likely to initiate opioids, but not to use them chronically. This was a particularly interesting finding given that women Veterans report a higher prevalence of painful conditions and use more care for treatment of these conditions. Indeed, in the analyses for this dissertation the prevalence of pain conditions was higher in women Veterans than in their male counterparts. Chapter 4 analyses examined the impact of opioid use on the risk of negative clinical outcomes among Veterans with TBI. Multiple analytic strategies were used; overall the models suggested that negative clinical outcomes were most strongly associated with any opioid use, rather than chronic use and that women were particularly likely to have a negative outcome. The findings suggest that the various opioid-related policies implemented prior to 2012 have had little impact and provide a baseline comparison for new policies implemented in 2013 and 2014. From a clinical perspective, this work suggests that clinicians should carefully consider when and how to prescribe opioids among individuals with TBI. However at this time, there are no specific clinical guidelines to help providers make these decisions, underscoring the need for more work in this area.
|Advisor:||Curran, Geoffrey M.|
|Commitee:||Bird, Tommy M., Booth, Brenda M., Owen, Richard R., Tilford, John M.|
|School:||University of Arkansas for Medical Sciences|
|Department:||Health Promotion and Prevention Research|
|School Location:||United States -- Arkansas|
|Source:||DAI-A 76/09(E), Dissertation Abstracts International|
|Subjects:||Public health, Public policy|
|Keywords:||Opioid drugs, Traumatic brain injury, Veterans health administration|
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