National Academies Press: OpenBook
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×

An Approach to Evaluate the
Effects of Concomitant
Prescribing of Opioids and
Benzodiazepines on Veteran
Deaths and Suicides

Committee on Developing a Protocol to Evaluate
the Concomitant Prescribing of Opioids and Benzodiazepine
Medications and Veteran Deaths and Suicides

Board on Health Care Services

Health and Medicine Division

A Consensus Study Report of

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by contracts between the National Academy of Sciences and the Department of Veterans Affairs (Contract No. 36C24518N3884). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-49599-8
International Standard Book Number-10: 0-309-49599-7
Digital Object Identifier: https://doi.org/10.17226/25532

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2019 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. An approach to evaluate the effects of concomitant prescribing of opioids and benzodiazepines on veteran deaths and suicides. Washington, DC: The National Academies Press. https://doi.org/10.17226/25532.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×

Image

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private nongovernment institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public-policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×

Image

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on studies’ statements of task by committees of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committees and the committees’ deliberations. Each report has been subjected to a rigorous and independent peer-review process and represents the position of the National Academies on its statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at workshops, symposia, or other events convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×

COMMITTEE ON DEVELOPING A PROTOCOL TO EVALUATE THE CONCOMITANT PRESCRIBING OF OPIOIDS AND BENZODIAZEPINE MEDICATIONS AND VETERAN DEATHS AND SUICIDES

BRIAN L. STROM (Chair), Chancellor of Rutgers Biomedical and Health Sciences, Rutgers University

AMY S. B. BOHNERT, Associate Professor of Psychiatry, University of Michigan

TOBIAS GERHARD, Associate Professor of Pharmacy and Epidemiology, Rutgers Biomedical and Health Sciences, Rutgers University

MIGUEL HERNÁN, Kolokotrones Professor of Biostatistics and Epidemiology, Harvard T.H. Chan School of Public Health

VAN LEWIS KING, JR., Professor of Psychiatry, The University of Texas Health Science Center at San Antonio

ROGER J. LEWIS, Chair of Emergency Medicine, Harbor-UCLA Medical Center

JESSICA S. MERLIN, Associate Professor of Medicine, University of Pittsburgh

SUSAN PADDOCK, Executive Vice President and Chief Statistician, NORC at the University of Chicago

Study Staff

CAROLYN FULCO, Scholar

BERNICE CHU, Program Officer

BLAKE REICHMUTH, Research Associate

JOSEPH GOODMAN, Senior Program Assistant

SHARYL NASS, Director, Board on Health Care Services

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×

Reviewers

This Consensus Study Report was reviewed in draft form by persons chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets institutional standards of quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following for their review of this report:

CHAD M. BRUMMETT, University of Michigan Medical School

BETH DARNALL, Stanford University School of Medicine

DAVID FIELLIN, Yale School of Medicine

SEAN HENNESSY, University of Pennsylvania

JENNIFER SHARPE POTTER, The University of Texas at San Antonio

SUSAN SHORTREED, Kaiser Permanente Washington Health Research Institute

JASVINDER A. SINGH, The University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×

recommendations of this report, nor did they see the final draft before its release. The review of the report was overseen by RODERICK J. LITTLE, University of Michigan, and LINDA C. DEGUTIS, Henry M. Jackson Foundation. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×

Acronyms and Abbreviations

AFD Adult Functioning and Disability supplement
CDC Centers for Disease Control and Prevention
CDW Corporate Data Warehouse
DoD Department of Defense
GABA gamma-aminobutyric acid
GAD Generalized Anxiety Disorder scale
IP inverse probability
MME morphine milligram equivalent
NDI National Death Index
NHIS National Health Interview Survey
NIDA National Institute on Drug Abuse
NSAID nonsteroidal anti-inflammatory drug
OEF Operation Enduring Freedom
OIF Operation Iraqi Freedom
OND Operation New Dawn
OSI Opioid Safety Initiative
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
PTSD posttraumatic stress disorder
RCT randomized controlled trial
SUD substance use disorder
TBI traumatic brain injury
VA Department of Veterans Affairs
VHA Veterans Health Administration
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
Page R1
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
Page R2
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
Page R3
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
Page R4
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
Page R5
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
Page R6
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
Page R8
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
Page R9
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
Page R10
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
Page R11
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides. Washington, DC: The National Academies Press. doi: 10.17226/25532.
×
Page R12
Next: Summary »
An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides Get This Book
×
Buy Paperback | $50.00 Buy Ebook | $40.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Opioid prescriptions for acute and chronic pain increased dramatically from the late 1990s into the current decade in both the civilian and the Department of Veterans Affairs and Department of Defense treatment environments. Similarly, prescriptions for benzodiazepines also increased significantly for anxiety and insomnia. Combinations of opioid and benzodiazepines have proven fatal when taken concurrently, with research demonstrating this phenomenon for nearly 40 years. This issue is exacerbated within the veteran population because of higher rates of pain, anxiety and other related health issues due to military life. An evaluation of the relationship between opioid and benzodiazepine medication practices at the VA is necessary to improve treatment for mental health and combat-related trauma for veterans.

An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides investigates the effects of opioid initiation and tapering strategies in the presence of benzodiazepines in veterans. This report explores neurobiology and the principles of addiction and tolerance, in addition to the current use of opioids and benzodiazepines for treating pain and anxiety in both the veteran and general population. It also provides a protocol to evaluate the relationship between opioid and benzodiazepine medication practices. This framework is a critical foundation for further research to improve concomitant opioid and benzodiazepine medication practices for veterans and the general population.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!