Evaluating the Effects of Opioids and Benzodiazepines on All-Cause Mortality in Veterans

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Veterans are more likely than non-veterans to experience pain, trauma, and mental health challenges due to training and combat-related service. Treatment often results in the prescription of opioid and benzodiazepine medications.

In 2024, the National Academies were tasked with convening a committee of experts to evaluate the effects of these medications on all-cause mortality of veterans, including suicide, regardless of whether information relating to such deaths was reported to the U.S. Centers for Disease Control and Prevention.

The resulting report examines newly dispensed opioid pharmacotherapy in veterans without and with current benzodiazepine pharmacotherapy; varying levels of the initial baseline dosage and dosage escalation of dispensed opioid pharmacotherapy; and newly dispensed benzodiazepine compared to alternative non-benzodiazepine pharmacotherapy in veterans with consistent opioid pharmacotherapy.

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334 pages · 8.5 x 11 · paperback
ISBN Paperback: 0-309-73133-X
ISBN Ebook: 0-309-73128-3
DOI: https://doi.org/10.17226/28584

Suggested citation

National Academies of Sciences, Engineering, and Medicine. 2025. Veterans, Prescription Opioids and Benzodiazepines, and Mortality, 2007–2019: Three Target Trial Emulations. Washington, DC: The National Academies Press.

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Brian L. Strom

Brian Strom, M.D., M.P.H., (Chair), is Chancellor of Rutgers Biomedical and Health Sciences and Executive Vice President for Health Affairs at Rutgers University. His major research interest is in pharmacoepidemiology, the application of epidemiologic methods to the study of drug use and effects. Dr. Strom is a member of the American Epidemiology Society, the American Society of Clinical Investigation, the American Association of Physicians, the National Academy of Medicine, and the American Association for the Advancement of Science. He received the 2003 Rawls-Palmer Progress in Medicine Award and the 2016 Oscar B. Hunter Career Award in Therapeutics from the American Society for Clinical Pharmacology & Therapeutics, the Naomi M. Kanof Clinical Investigator Award of the Society for Investigative Dermatology, and the Sustained Scientific Excellence Award from the International Society for Pharmacoepidemiology. He was the 2008 recipient of the John Phillips Memorial Award for Outstanding Work in Clinical Medicine, and the 2013 Association for Clinical and Translational Science/American Federation for Medical Research National Award for Career Achievement and Contribution to Clinical and Translational Science for translation from clinical use into public benefit and policy. Dr. Strom had an advisory role with Jansen Pharmaceuticals/Johnson and Johnson from 2017-2019. He was awarded an honorary doctorate from the University of Thrace in Greece.
Dr. Strom chaired the IOM/NAM Committees to Assess the Safety and Efficacy of the Anthrax Vaccine, the Committee on Smallpox Vaccine Program Implementation, the Committee to Review NIOSH’s Traumatic Injury Program, the Committee on the Consequences of Reducing Sodium in the Population, the Committee on a National Strategy for the Elimination of Hepatitis B and C and the Committee on Development of a Protocol to Evaluate the Concomitant Prescribing of Opioid and Benzodiazepine Medications and Veterans Deaths and Suicides. He was a member of the Committee on Standards for Developing Trustworthy Clinical Practice Guidelines and the IOM Drug Forum. Dr. Strom earned a BS in Molecular Biophysics and Biochemistry from Yale in 1971, an MD from Johns Hopkins in 1975, residency in Internal Medicine and fellowship in Clinical Pharmacology, both at UCSF, and an MPH in Epidemiology at UC Berkeley.

Amy Susan Buchanan Bohnert

Amy S. B. Bohnert, Ph.D., is a Professor of Anesthesiology and Executive Director for Pain and Opioid Research at the University of Michigan. She is also a research investigator with VA’s Center for Clinical Management Research in Ann Arbor, Michigan. She leads epidemiologic and health services research related to overdose and suicide, prescription drug safety, addiction, and Veteran health. Dr. Bohnert is a member of the Stanford-Lancet Commission on the North American Opioid Crisis and has served on CDC and FDA advisory panels. Dr. Bohnert earned her PhD in Public Health at Johns Hopkins University and completed her postdoctoral fellowship with the Department of Veterans Affairs, National Serious Mental Illness Treatment Research and Evaluation Center in Ann Arbor, MI. Dr. Bohnert also serves as an expert for the State of Michigan to develop an abatement plan to address opioid-related harms in Michigan.
She served on the NAS Committee on Developing a Protocol to Evaluate the Concomitant Prescribing of Opioids and Benzodiazepine Medications and Veteran Deaths and Suicides.

Adam P. Bress

Adam Bress, Pharm.D., M.S., is a formally trained cardiovascular clinical pharmacist and pharmacoepidemiologist. He is an Associate Professor with Tenure and Vice Chair of Research for the Department of Population Health Sciences at the University of Utah Spencer Fox Eccles School of Medicine. Dr. Bress is also an Investigator at the VA Salt Lake City Health Care System. His expertise includes the application of causal inference methods to study medication use, responses, and outcomes in large EHR and claims databases. He is an NIH-funded PI, and his team uses causal inference methods in the Veterans Health Administration and Kaiser Permanente Southern California data to determine the long-term comparative effects of antihypertensive medications on the risk of dementia, cardiovascular disease, cancer, and frailty. He has successfully designed, led, and published several manuscripts investigating medication use and effects using VA data. He has substantial experience in building high-quality analysis-ready data sets from VA data and implementing rigorous causal inference methods accounting for time-varying treatment and confounding, out-of-system healthcare utilization, and intercurrent events.
Dr. Bress received his Doctor of Pharmacy degree from the University of Maryland, and his Master of Science in Clinical and Translational Science from the University of Illinois at Chicago School of Public Health. He completed his residency in pharmacy practice at Yale-New Haven Hospital and Cardiology at the University of Illinois at Chicago. He subsequently completed his post-doctoral research fellowship at the University of Illinois at Chicago. He was the 2020 National Academy of Medicine Fellow in Pharmacy and a former NHLBI K-awardee.

Carl A. Castro

Carl A. Castro, Ph.D., M.A., is a professor, director of the Center for Innovation and Research on Veterans & Military Families, and director of Military Veterans Programs at the USC Suzanne Dworak-Peck School of Social Work. Professor Castro also serves as director of the USC-RAND Epstein Family Foundation Center for Veterans Policy Research. Professor Castro joined the faculty in 2013.
Before joining the University of Southern California, Professor Castro served in the U.S. Army for over 30 years, beginning his career as an enlisted infantryman and retiring at the rank of colonel. He served in a variety of research and leadership positions, including as director of the Military Operational Medicine Research Program, Headquarters, U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland. Professor Castro has completed two tours in Iraq, as well as peacekeeping missions to Saudi Arabia, Bosnia and Kosovo. Professor Castro has chaired numerous NATO and international research groups and is currently co-chair of a NATO group exploring military and veteran violent radicalization. He is a Fulbright Scholar and member of several Department of Defense research advisory panels focused on psychological health.
Professor Castro has authored more than 300 scientific articles and reports in numerous research areas. His current research efforts focus on assessing the effects of combat and operations tempo (OPTEMPO) on soldier, family and unit readiness, and evaluating the process of service members’ transitions from military to civilian life.

Lesley H. Curtis

Lesley H. Curtis, Ph.D., is Professor of the Department of Population Health Sciences in the Duke School of Medicine. A health services researcher by training, Dr. Curtis is an expert in the use of Medicare claims data for health services and clinical outcomes research, and a leader in national data quality efforts. Dr. Curtis has served as co-PI of the FDA’s Sentinel Innovation Center, Co-Investigator of the Data Core for the FDA’s Sentinel Initiative to monitor the safety of FDA-regulated medical products, and co-Investigator of the coordinating center for PCORI’s National Clinical Research Network (PCORnet). She currently serves as co-PI of the NIH Pragmatic Trials Collaboratory, an effort to strengthen the national capacity to implement cost-effective, large-scale research studies that engage health care delivery organizations as research partners. As of July 2023, Dr. Curtis is supporting the FDA Office of the Commissioner’s initiative to improve national systems for evidence generation.

John T. Farrar

John T. Farrar, Ph.D., M.D., M.S., is Professor of Epidemiology, Neurology, and Anesthesiology and Critical Care at the University of Pennsylvania Perelman School of Medicine. He received his MD from the University of Rochester School of Medicine, and his PhD in pharmaco-epidemiology from the University of Pennsylvania Perelman School of Medicine. He is a board-certified neurologist with a subspecialty in Pain Medicine and a PhD in epidemiology who has spent his career studying pain, pain measurement, and pain therapies. He has conducted clinical trials and specializes in the use of large patient data sets in his research publishing over 200 articles. He has been continuously funded through NIH and the FDA. He has been a member of several NASEM committees in the past including the: National Academy of Science Panel, Handling Missing Data in Clinical Trials (2009-10); Institute of Medicine Committee, Report on Relief of Pain in America (2010-11); and NASEM Panel, Report on Compounded Topical Pain Creams (2019-20). He has served as a standing member and then chair of the Food and Drug Administration, Anesthetic and Life Support Drugs Advisory Board.

Robert Kerns

Robert Kerns, Ph.D., M.A., is senior research scientist in the Yale School of Medicine Department of Psychiatry and professor emeritus, Yale University. Dr. Kerns retired from the Department of Veterans Affairs (VA) in 2016 after 38 years of service, where he held several leadership positions including Director of the Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation (2008-2016) at the VA Connecticut Healthcare System, and as VA National Program Director for Pain Management (2005-2013). He is currently a director of the NIH-DOD-VA Pain Management Collaboratory Coordinating Center that supports 14 pragmatic clinical trials of nonpharmacological approaches for the management of pain and common co-occurring conditions in military and veteran health systems. His scholarly and scientific contributions focus on comprehensive pain assessment, nonpharmacological approaches for the management of pain, individual differences and disparities in pain care, safe and effective opioid therapy, and organizational improvements in pain care. Through an intergovernmental personnel agreement (IPA) between Yale and the VA, Dr. Kerns is a subject matter expert and research investigator at VA’s PRIME Center in West Haven, CT.
Dr. Kerns is the recipient of numerous honors and awards, including the 2006 David M. Worthen Award for Academic Excellence and the 2006 Mark Wolcott Award for Clinical Leadership from VA, the 2010 John and Emma Bonica Public Service Award, and 2017 Wilbert E. Fordyce Clinical Investigator Award from the American Pain Society. He served as a member of the Institute of Medicine Committee for Advancing Pain Research, Care and Education. He received his undergraduate degree in Psychology at West Virginia University in 1974 and his doctoral degree in Bio-Clinical Psychology at Southern Illinois University in 1980. (Biography updated 3.21.2024).

Mathew Vinnhoa Kiang

Mathew Kiang, Sc.D., M.P.H., is an assistant professor in the Department of Epidemiology and Population Health at Stanford University School of Medicine. He is a computational social scientist and social epidemiologist whose research focuses on socioeconomic and racial/ethnic inequities in health, especially around substance use and mortality. His recent work has examined ways in which the COVID-19 pandemic has impacted opioid-related mortality in the US. His NIH-funded projects examine ways to improve initiation and retention in the treatment of opioid use disorder and ways to leverage novel data sources to predict opioid-related mortality.
Dr. Kiang received his doctorate in quantitative methods and social epidemiology from the Harvard TH Chan School of Public Health in the Department of Social and Behavioral Sciences and his MPH from New York University. Before becoming an assistant professor, Dr. Kiang was a postdoctoral research fellow at the Stanford Systems Neuroscience and Pain Laboratory, was a fellow in the Data Science for Social Good fellowship at the University of Chicago, and a fellow at the Harvard FXB Center for Health and Human Rights.

Hsien-Chang Lin

Hsien-Chang Lin, Ph.D., M.A.E, M.A., Professor of Health Behavior and Policy and Chair of the Department of Child and Family Development at San Diego State University.
Dr. Lin has a strong research program in the prevention, treatment, and effect of substance use behaviors, as well as how the healthcare system interplays. Leveraging his expertise and research experiences in substance use and pharmacoepidemiology, he has conducted several studies examining physicians’ prescribing practice and patients’ use/misuse of opioid painkillers and benzodiazepines among patients with chronic pain, and how the healthcare system and healthcare policy influence these behaviors. Dr. Lin’s substance use research has important mental and psychological health aspects, including the investigation of substance use behaviors among people with mental health conditions, the psychological pathways through which risk factors and substance use behaviors are connected, the effect of substance use on affect, and how emotion dynamics are associated with substance use.
Dr. Lin is active in the profession. He recently served as the President the American Academy of Health Behavior, where he is a fellow. Dr. Lin has an interdisciplinary educational background including economics (BA and two MAs), sociology (BA), healthcare system and policy (PhD), pharmacoepidemiology (PhD), and health outcomes research (Post doc).

Miguel Marino

Hsien-Chang Lin, Ph.D., M.A.E, M.A., Professor of Health Behavior and Policy and Chair of the Department of Child and Family Development at San Diego State University.
Dr. Lin has a strong research program in the prevention, treatment, and effect of substance use behaviors, as well as how the healthcare system interplays. Leveraging his expertise and research experiences in substance use and pharmacoepidemiology, he has conducted several studies examining physicians’ prescribing practice and patients’ use/misuse of opioid painkillers and benzodiazepines among patients with chronic pain, and how the healthcare system and healthcare policy influence these behaviors. Dr. Lin’s substance use research has important mental and psychological health aspects, including the investigation of substance use behaviors among people with mental health conditions, the psychological pathways through which risk factors and substance use behaviors are connected, the effect of substance use on affect, and how emotion dynamics are associated with substance use.
Dr. Lin is active in the profession. He recently served as the President the American Academy of Health Behavior, where he is a fellow. Dr. Lin has an interdisciplinary educational background including economics (BA and two MAs), sociology (BA), healthcare system and policy (PhD), pharmacoepidemiology (PhD), and health outcomes research (Post doc).

Anne Marie McKenzie-Brown

Anne Marie McKenzie-Brown, M.D., is Interim Chair of the Department of Anesthesiology, Vice Chair for Professional Development, and a professor at Emory University. Dr. McKenzie-Brown is board certified in anesthesiology and pain medicine. After anesthesiology residency at Emory University, she returned to Johns Hopkins and did fellowship training in pain medicine before returning to Emory on faculty. Dr. McKenzie-Brown was the initial Program Director of the Emory Multidisciplinary Pain Fellowship for 14 years; a fellowship that trains future pain physicians and comes from multiple specialties, training together to become the best pain practitioners and educators. She was the Division Chief of the Emory Pain Division and the Medical Director of the Emory Pain Center for almost 20 years and is now the Vice Chair of Professional Development in the Department of Anesthesiology at Emory. She is a member of many professional organizations, including the American Society of Interventional Pain Physicians, The American Society of Regional Anesthesiology and Pain Medicine, and the Spinal Injection Society. She is a senior board examiner and member of the American Board of Anesthesiology and member of the American Society of Anesthesiology.
Dr. McKenzie-Brown’s interests include the treatment of neck and back pain using nonopioid therapies, including interventional pain therapies such as spinal cord and peripheral nerve stimulation and complementary therapies for pain. Her goal is to use opioid-free pain-relieving techniques to treat pain in a healthy way.

Patience Moyo Dow

Patience Moyo is an Assistant Professor of Health Services, Policy, and Practice at the Brown University School of Public Health where she is affiliated with the Center for Gerontology and Healthcare Research. Dr. Moyo obtained doctoral training in pharmaceutical health services research from the University of Maryland Baltimore and completed postdoctoral training in pharmaceutical policy at the University of Pittsburgh and at VA Pittsburgh Healthcare System. She has expertise in the use of large administrative data to conduct epidemiologic and policy analyses relating to health services use, quality of care, and outcomes. Dr. Moyo had an interagency personnel agreement (IPA) with Philadelphia VA Medical Center and Providence VA Medical Center between 2020 and 2022 and more recently will have a one-year IPA appointment with the Providence VA Medical Center, beginning on September 25, 2023, on a project related to homelessness and long-term care among Veterans.
Dr. Moyo’s current research focuses on the management of pain and opioid use disorder and involves policy analyses related to the treatment of these conditions. She also carries out qualitative research focused on understanding post-acute and long-term care use by persons with opioid use disorder.

Katie J. Suda

Patience Moyo Dow, Ph.D., is an Associate Professor of Health Services, Policy, and Practice at the Brown University School of Public Health. Dr. Dow's research focuses on the management of pain and opioid use disorder and often includes the use of large administrative databases to conduct epidemiologic and policy analyses relating to health services use, quality of care, and outcomes. She also carries out qualitative research focused on understanding post-acute and long-term care use by individuals with opioid use disorder. Between 2020 and 2022, through an interagency personnel agreement (IPA), Dr. Dow collaborated with researchers at the Philadelphia VA Medical Center to study opioid prescribing patterns among veterans with cancer and with the Providence VA Medical Centers to study outcomes of VA-purchased care in the community. As of September 2023, Dr. Dow has an active IPA appointment with the Providence VA Medical Center on a project related to homelessness and long-term care among veterans.
Dr. Dow obtained doctoral training in pharmaceutical health services research from the University of Maryland Baltimore and completed her postdoctoral fellowship with the Health Policy Institute at the University of Pittsburgh and the Center for Health Equity Research and Promotion at the VA Pittsburgh Healthcare System.

Closed

Evaluating the Effects of Opioids and Benzodiazepines on All-Cause Mortality in Veterans: Meeting 5

July 20 - 21, 2023

Past

About

The Committee to Evaluate the Effects of Opioids and Benzodiazepines on All-Cause Mortality of Veterans held its fifth meeting on July 20 and 21, 2023. This was a closed meeting, and the committee discussed report progress and data considerations.

Additional Information

Is it a Closed Session event?

Institution Closed

The following committee members were present at the closed sessions of the event

Brian Strom
Amy Bohnert
Adam Bress
Carl Castro
Lesley Curtis
John Farrar
Robert Kerns
Mathew Kiang
Hsein-Chang Lin
Anne Marie McKenzie-Brown
Patience Moyo
Katie Suda

The following topics were discussed in the closed sessions:

The following topics were discussed during the closed session:
-Project Updates (SOT Review, Project Timeline, including VA Data Acquisition)
-VA Opioids Dashboard: Summary
- Review of VA Small Sample Size Response
-Veterans Engagement Panel (VEP) Summary
-Protocol Discussion
-Review of Opioid Tapering Studies
-Overview of Initial Report Outline

Contact

Contact us

VAopioids@nas.edu

Disclaimer

It is essential to the National Academies mission of providing evidence-based advice that participants in any of our meetings or events avoid political or partisan statements or commentary and maintain a culture of mutual respect. The statements and presentations during our meetings or events are solely those of the individual participants and do not necessarily represent the views of other participants or the National Academy of Sciences, which is a non-partisan, tax exempt organization that includes under its Charter the National Academy of Engineering and National Academy of Medicine, and that operates the National Research Council.

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Evaluating the Effects of Opioids and Benzodiazepines on All-Cause Mortality in Veterans

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Evaluating the Effects of Opioids and Benzodiazepines on All-Cause Mortality in Veterans

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Featured publication

Veterans, Prescription Opioids and Benzodiazepines, and Mortality, 2007–2019: Three Target Trial Emulations

Description

Contributors

Committee

Sponsors

Staff

Parent projects

Board on Population Health and Public Health Practice

Major units and sub-units

Contact

Provide feedback

Request materials

More like this

Review of the draft United by Nature assessment

Modernizing Mathematics Education for Grades 9-14

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Review of the draft United by Nature assessment

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