Risk Factors for Chronic Prescription Opioid Use in Multiple Sclerosis.

OBJECTIVE: To characterize patterns of prescription opioid use among individuals with multiple sclerosis (MS) and identify risk factors associated with chronic use. DESIGN: Retrospective longitudinal cohort study examining US Department of Veterans Affairs electronic medical record data of Veterans with MS. The annual prevalence of prescription opioid use by type (any, acute, chronic, incident chronic) was calculated for each study year (2015-2017). Multivariable logistic regression was used to identify demographics and medical, mental health, and substance use comorbidities in 2015-2016 associated with chronic prescription opioid use in 2017. SETTING: US Department of Veterans Affairs, Veteran's Health Administration. PARTICIPANTS: National sample of Veterans with MS (N=14,974). MAIN OUTCOME MEASURE: Chronic prescription opioid use (≥90 days). RESULTS: All types of prescription opioid use declined across the 3 study years (chronic opioid use prevalence=14.6%, 14.0%, and 12.2%, respectively). In multivariable logistic regression, prior chronic opioid use, history of pain condition, paraplegia or hemiplegia, post-traumatic stress disorder, and rural residence were associated with greater risk of chronic prescription opioid use. History of dementia and psychotic disorder were both associated with lower risk of chronic prescription opioid use. CONCLUSION: Despite reductions over time, chronic prescription opioid use remains common among a substantial minority of Veterans with MS and is associated with multiple biopsychosocial factors that are important for understanding risk for long-term use.

Access to multiple sclerosis specialty care.

BACKGROUND: Health care providers recommend an annual visit to a multiple sclerosis specialty care provider. OBJECTIVE: To examine potential barriers to the implementation of this recommendation in the Veterans Health Administration. DESIGN: Observational cohort study. SETTING: Veterans Health Administration. PARTICIPANTS: Participants were drawn from the Veterans Affairs Multiple Sclerosis National Data Repository and were included if they had an outpatient visit in 2007 and were alive in 2008 (N = 14,723). MAIN OUTCOME MEASUREMENTS: Specialty care visit, receipt of medical services. RESULTS: A total of 9643 (65.5%) participants had a specialty care visit in 2007. Veterans who were service connected, had greater medical comorbidity, and who lived in urban settings were more likely to have received a specialty care visit. Veterans who were older and had to travel greater distances to a center were less likely to have a specialty care visit. CONCLUSIONS: Access to care in rural areas and areas at a greater distance from a major medical center represent notable barriers to rehabilitation and other multiple sclerosis-related care.

The prevalence of overweight and obesity in veterans with multiple sclerosis.

OBJECTIVES: To estimate the prevalence and factors associated with overweight and obesity in veterans with multiple sclerosis (MS) enrolled in the Veterans Health Administration (VA) and to compare the prevalence in this group with gender-specific published rates for the general population of veterans receiving outpatient care at VA medical facilities. DESIGN: Cross-sectional cohort study linking electronic medical record information to mailed survey from 1999 to 2004. A total of 4703 veterans with MS enrolled in VA who returned questionnaires as part of two cross-sectional studies. Main outcome measures included body mass index, demographic information, Veteran RAND 36-item Health Survey, frequency of physical exercise, and other health conditions. RESULTS: Overall, 28% of female and 42.8% of male veterans with MS were overweight. Another 25% of women and 21.2% of male veterans met the criteria for obesity. Compared with a historical cohort of veterans enrolled in the VA, veterans with MS had a slightly higher adjusted prevalence of overweight than did veterans in general (42.3% vs. 39.6%, respectively) but a lower adjusted prevalence of obesity (20.1% vs. 33.1%). In adjusted logistic regression, age, smoking, and lower levels of pain were associated with a lower likelihood of overweight or obesity. Being male, married, employed and having arthritis and diabetes were associated with a greater likelihood of overweight or obesity. CONCLUSIONS: Overweight and obesity are a problem for more than 60% of veterans with MS in the VA. Screening for overweight and obesity should be done routinely. Interventions to prevent and manage excessive weight in individuals with MS should be developed and evaluated.