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