Opioid Use Disorder Diagnosis After Low Back Pain Diagnosis in Active Duty, Retired, and Veteran Service Members: A Time-To-Event Cohort Study

Abstract Objective This study quantified time-to-opioid use disorder diagnosis after low back pain diagnosis in military-connected patients and evaluated predictors of opioid use disorder over time. Design Time-to-event cohort. Setting Data obtained from the Department of War and Veterans Administration Infrastructure for Clinical Intelligence. Subjects National sample of active duty, retired, and veteran service members diagnosed with low back pain July 2016 - March 2023. Methods The primary outcome was time-to-opioid use disorder diagnosis up to 52 weeks after low back pain diagnosis. Fixed covariates: Patient characteristics, diagnosis site, and comorbidity scores. Time-dependent covariates: Co-occurring substance use, psychiatric, and medical conditions, and pharmacological and non-pharmacological pain treatments. Results Among 3,444,921 patients, 20,076 (0.6%) received an opioid use disorder diagnosis within 52 weeks after low back pain diagnosis. Average hazard ratios for opioid use disorder were significantly higher for retired service members and veterans versus active duty personnel, and for those with nicotine dependence, other substance use, and psychiatric comorbidities. Statistically significant time-varying variables included veteran status, greater medical comorbidities, purchased care system for low back pain diagnosis; substance use disorder, other pain, and obesity; days supply of opioids; days of secondary and tertiary pain therapies; and number of antidepressant, sedative, and non-opioid prescriptions. Conclusions Findings highlight the need for opioid use disorder mitigation efforts for veterans and retired service members with low back pain, particularly those with co-occurring substance use and psychiatric diagnoses, who are prescribed opioids, or who receive intensive pain treatment close to their low back pain diagnosis date.