# Effects of Opioid and Other Psychotropic Drug Exposures on Long-term Outcomes of TBI: Developing Measurement Best Practices

> **NIH VA I21** · PORTLAND VA MEDICAL CENTER · 2020 · —

## Abstract

Project Background/Rationale: Traumatic brain injury (TBI), even mild TBI/concussion, is known to be
associated with Alzheimer's disease and other progressive neurological disorders in both Veteran and non-
Veteran populations. The VA cares for a large number of Veterans who have incurred TBI. Many of these
Veterans are also treated inside and outside the VA for comorbid pain and mental health disorders, often with
opioid and other psychotropic medications. These medications may contribute to the risk of adverse
neurological outcomes. Although the VA has reduced opioid prescribing in recent years, many Veterans with
TBI continue to receive these medications from providers both inside and outside the VA. In the post-9/11
combat era, in which TBI has been deemed the “signature” injury of war, and in the context of the US opioid
epidemic, research is needed to examine the effects of opioids and other psychotropic medication use on the
long-term neurological outcomes of Veterans with TBI history.
Longitudinal approaches using VA administrative data and clinical research will both contribute to this field of
study. However, these approaches are hampered by important methodological limitations. First, although VA
administrative data (i.e. medical records) are a powerful source of information on health diagnoses, healthcare
utilization, and prescription dispensation for the millions of Veterans who use VA healthcare annually, the
validity of using TBI-related diagnosis codes in administrative data to identify Veterans with TBI is
questionable. And second, although clinical studies have been designed specifically to examine the causal
effects of TBI on neurological outcomes, these studies may lack complete data (i.e., VA and non-VA) on
Veterans' psychotropic medication exposures. Research examining the validity of TBI-related diagnosis codes,
and methods to collect Veterans' complete medication exposures, will help advance this field significantly.
Project Aims: This project will develop best practices for epidemiologic and clinical research, and serve as the
foundation for a new research program, that evaluates the impact of opioids and other psychotropic
medications on the long-term neurological outcomes of Veterans with TBI history. The specific aims are to: (1)
Identify valid approaches for identifying Veterans with TBI in VA administrative data; and (2) Develop methods
to measure Veterans' complete opioid and other psychotropic medication exposures in clinical research
examining the effects of these medications on long-term outcomes of Veterans with TBI.
Project Methods: The proposed 2-year project will generate the methods and preliminary data needed for
subsequent research focused on opioids and neurological health among Veterans with TBI. This project will
use VA administrative data (Aims 1 and 2), and state prescription drug monitoring program (PDMP) data (Aim
2), to develop reproducible and scalable approaches to valid TBI and medication measur...

## Key facts

- **NIH application ID:** 9964517
- **Project number:** 5I21RX003197-02
- **Recipient organization:** PORTLAND VA MEDICAL CENTER
- **Principal Investigator:** Kathleen F. Carlson
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-07-01 → 2021-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9964517

## Citation

> US National Institutes of Health, RePORTER application 9964517, Effects of Opioid and Other Psychotropic Drug Exposures on Long-term Outcomes of TBI: Developing Measurement Best Practices (5I21RX003197-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9964517. Licensed CC0.

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