Prescription opioid use and substance use disorder in US women (2006–2022): a retrospective cohort study

Background: Research has shown that multiple deployments may have adverse effects on active-duty servicewomen and women civilian dependents of active-duty servicemembers. There is concern that the associated stress could induce sustained prescription opioid use and substance use disorder (SUD). We sought to evaluate the incidence of sustained opioid use and SUD among servicewomen and women civilian dependents during 2006–2013, a period of increased operational intensity, compared to similar individuals in 2014–2022. Methods: We employed Military Health System claims data to identify servicewomen and dependents who were diagnosed with SUD or demonstrated sustained prescription opioid use (i.e., six months of uninterrupted use). The incidence of sustained opioid use (primary outcome) and SUD associated (secondary outcome) with 2006–2013 was compared to 2014–2022 among servicewomen and dependents. Multivariable log binomial regression was used to adjust for confounding. Ethnicity was not available in our dataset. Findings: 4,876,209 individuals were included. The average age (standard deviation [SD]) of the cohorts under study were 26.6 (SD 8.2) for active duty 2006–2013, 26.0 (SD 8.0) for active duty 2014–2022, 35.3 (SD 13.1) for dependents 2006–2013 and 33.6 (SD 12.1) for dependents 2014–2022. Compared to civilian dependents in 2014–2022, servicewomen from 2006 to 2013 demonstrated an increased risk of sustained prescription opioid use (RR 1.49, 95% CI 1.46–1.53). In 2014–2022, servicewomen had a lower risk compared to dependents (RR 0.47, 95% CI 0.45–0.49), while dependents in 2006–2013 were also at higher risk (RR 1.58, 95% CI 1.56–1.60). Servicewomen in 2006–2013 were at significantly greater risk of developing SUD (RR 1.07, 95% CI 1.06–1.08). During 2014–2022, servicewomen displayed a lower risk when compared to dependents (RR 0.80, 95% CI 0.79–0.81). Dependents in 2006–2013 showed a higher risk (RR 1.24, 95% CI 1.24–1.25). Interpretation: We found significant increases in the risks of sustained opioid use and SUD among servicewomen and civilian dependents during a period of increased operational intensity (2006–2013). We believe these findings reflect the deleterious effects of emotional stress, insufficient support structures, and military sexual trauma. Funding: U.S. Department of Defense, Defense Health Agency (#HU00012320021).