Investigating the Impact of Prescribed Opioids, Benzodiazepines on Veterans

Rutgers Biomedical and Health Sciences Chancellor Brian Strom leads investigation of the medications’ co-prescription and veteran overdoses and deaths

Are veterans who simultaneously take opioids for chronic pain and benzodiazepines for anxiety and insomnia at an increased risk of unintentional overdose and death as well as suicide?

Nearly 17 veterans die by suicide each day in the United States, a statistic that has led the Department of Veterans Affairs (VA) to make suicide prevention its highest priority and to recognize the risks from the simultaneous use of opioids and benzodiazepines. To tackle the issue, the VA asked the National Academies of Sciences, Engineering and Medicine (NASEM) to convene a committee of experts to evaluate the effects of opioid and benzodiazepine use on all-cause mortality of U.S. veterans, including suicide.

The committee, chaired by Brian Strom, the chancellor of Rutgers Biomedical and Health Sciences, will quantify the effects of opioid and benzodiazepine prescribing on the risk of death among veterans who received care from the VA between 2007 and 2019. In their analysis, the committee will focus on the effect of opioid prescribing for pain relative to alternative non-opioid pain treatments; the effects of higher doses relative to lower doses of opioids; the effect of co-prescribing a benzodiazepine among patients already receiving opioids relative to alternative treatments for anxiety and other indications for benzodiazepines; and the effect of initiating opioids among patients already taking benzodiazepines.

In 2019, Strom served as chair for a similar but separately funded NASEM committee that developed protocols that this committee will be considering.

The study is congressionally mandated through the Commander John Scott Hannon Veterans Mental Health Care Improvement Act (Hannon Act) of 2019, which broadens mental health care and suicide prevention programs that will effectively evaluate and treat mental health conditions for veterans.

The committee will research and deliberate on this issue and hopes to release the report within the next two years.

“Understanding the effects could help inform the use of opioid treatment as part of chronic pain management,” said Strom.

Additional committee members include:

• Amy Susan Buchanan Bohnert, Professor of Anesthesiology; Executive Director for Pain and Opioid Research, University of Michigan
• Adam P. Bress, Associate Professor and Vice Chair of Research for the Department of Population Health Sciences at the University of Utah Spencer Fox Eccles School of Medicine; Investigator at the VA Salt Lake City Health Care System
• Carl A. Castro, Professor, Director of the Center for Innovation and Research on Veterans & Military Families; Director of Military Veterans Programs, University of Southern California Suzanne Dworak-Peck School of Social Work
• Lesley H. Curtis, Professor and Chair of the Department of Population Health Sciences, Duke School of Medicine
• John T. Farrar, Professor of Epidemiology, Neurology and Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine
• Robert Kerns, Professor of Psychiatry, Neurology and Psychology, Yale University
• Mathew  Kiang, Assistant Professor,  Department of Epidemiology and Population Health, Stanford University School of Medicine
• Hsien-Chang Lin, Associate Professor, Interim Associate Dean for Faculty Recruitment, Indiana University School of Public Health in Bloomington
• Miguel Marino, Associate Professor of Biostatistics, Oregon Health & Science University
• Anne Marie McKenzie-Brown, Professor of Anesthesiology; Vice Chair, Professional Development, Department of Anesthesiology, Emory University.
• Patience Moyo, Assistant Professor of Health Services, Policy and Practice, Brown University School of Public Health
• Katie J. Suda, Professor, University of Pittsburgh Schools of Medicine and Pharmacy; Clinical Pharmacist Specialist, Research Health Scientist and Associate Director of Clinical Therapeutics with the VA Center for Health Equity Research and Promotion