Veterans’ OUD Diagnoses Increased From 2005 to 2017, Then Declined
The prevalence of opioid use disorder (OUD) diagnoses increased from 2005 to 2017, peaked in 2017, and then declined until 2022, according to a recent cross-sectional study of national Veterans Health Administration (VHA) electronic health record data published in JAMA Network Open.
“Overall, decreasing cases of OUD may reflect the success of numerous VHA and public health initiatives aimed at combating the opioid crisis that emphasized the implementation of medication-assisted OUD treatments, particularly in primary care settings,” authors noted. “Although OUD diagnoses were found to be declining, OUD prevalence in 2022 was substantially higher than in 2005, and continued public health efforts aimed at recognizing, treating, and preventing OUD are warranted.”
Related: Minority of Patients With OUD Develop PW After Buprenorphine Initiation
Researchers examined data from the VHA Corporate Data Warehouse. Adults with a current OUD diagnosis (using International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] codes) who received outpatient care at VHA facilities from January 1, 2005, to December 31, 2022, were eligible for inclusion. To examine changes in OUD prevalence over time, multivariable logistic regression models were run that included categorical study year and were adjusted for sex, race and ethnicity, and categorical age.
The total number of participants ranged from 4,332,165 to 5,962,564 per year, of whom 89.3% to 95% were men. The annual percentage of VHA patients diagnosed with OUD nearly doubled from 2005 to 2017 (0.60% [0.60%-0.61%] to 1.16% [1.15%-1.17%]; adjusted difference, 0.55 [0.54-0.57] percentage points) and declined afterward (2022: 0.97% [0.97%-0.98%]; adjusted difference from 2017 to 2022, −0.18 [−0.19 to −0.17] percentage points). This trend was similar among men (0.64% [0.63%-0.64%] in 2005 vs 1.22% [1.21%-1.23%] in 2017 vs 1.03% [1.02%-1.04%] in 2022), women (0.34% [0.32%-0.36%] in 2005 vs 0.68% [0.66%-0.69%] in 2017 vs 0.53% [0.52%-0.55%] in 2022), those younger than 35 years (0.62% [0.59%-0.66%] in 2005 vs 2.22% [2.18%-2.26%] in 2017 vs 1.00% [0.97%-1.03%] in 2022), those aged 35 to 64 years (1.21% [1.19%-1.22%] in 2005 vs 1.80% [1.78%-1.82%] in 2017 vs 1.41% [1.39%-1.42%] in 2022), and non-Hispanic White patients (0.44% [0.43%-0.45%] in 2005 vs 1.28% [1.27%-1.29%] in 2017 vs 1.13% [1.11%-1.14%] in 2022).
Among VHA patients aged 65 years or older, OUD diagnoses increased from 2005 to 2022 (0.06% [0.06%-0.06%] to 0.61% [0.60%-0.62%]), whereas among Hispanic or Latino and non-Hispanic Black patients, OUD diagnoses decreased from 2005 (0.93% [0.88%-0.97%] and 1.26% [1.23%-1.28%], respectively) to 2022 (0.61% [0.59%-0.63%] and 0.82% [0.80%-0.83%], respectively).
Researchers highlighted a few study limitations that may have restricted results. First, due to the use of ICD-9-CM and ICD-10-CM diagnosis codes rather than structured research assessments, some patients with OUD may have been missed by the analysis. Second, patients in the VHA are not representative of all veterans or all adults, so results may not be generalizable to the wider public. Third, the VHA database does not include a variable for nonprescription opioid use, so “trends in OUD diagnoses among patients who use illicit vs prescription opioids could not be examined.”
