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U.S. veterans of the wars in Iraq and Afghanistan who have post-traumatic stress disorder (PTSD) and other psychiatric disorders are more likely than veterans without mental health issues to receive prescription opioids for pain, according to a new study.

“Veterans using these narcotic painkillers had worse clinical outcomes,” lead researcher Dr. Karen Seal of the San Francisco Veterans Affairs Medical Center told HealthDay. “Those outcomes were wounds and injuries, alcohol and drug overdoses, opioid overdoses, violent injuries and even suicide. This was particularly true in the group with PTSD.”

The study found veterans with PTSD were more than twice as likely to receive opioids compared with veterans without mental health problems.

The study included 141,029 veterans who received at least one non-cancer-related pain diagnosis within a year of entering the Department of Veterans Affairs health care system. A total of 15,676 veterans were prescribed opioids within one year of their initial pain diagnosis.

The study found 17.8 percent of veterans with PTSD and 11.7 percent of veterans with other mental health diagnoses received opioids for pain, compared with 6.5 percent of veterans without mental health disorders. Of those who were prescribed pain medication, 22.7 percent of veterans with PTSD received higher-dose opioids, compared with 15.9 percent of those without mental health disorders. Veterans with PTSD were also more likely to receive two or more opioids together, and to obtain early opioid refills.

“Returning combat veterans are presenting to primary care in large numbers and are seeking relief from physical and psychological pain. Extra care should be taken when prescribing opioids to relieve their distress,” the researchers note in a news release. “Integrated treatments that target both mental health disorders and pain simultaneously are effective for both problems and may decrease harms resulting from opioid therapy.”

The results appear in the Journal of the American Medical Association.

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