Self-reported prescription medication use and polypharmacy following physical combat injury in the UK: the ADVANCE cohort study

Introduction The consequences of serious physical traumatic injury may require pharmacological intervention, however long-term use and polypharmacy can increase risk of morbidity/mortality. This study aims to describe prescription medication use in a cohort of UK Armed Forces personnel who sustained physical combat injuries during the Afghanistan conflict (injured group) compared to demographically similar personnel without such injuries (uninjured group) a median of 11 years post injury. Methods One thousand and fifty one participants of the ADVANCE cohort (injured group n = 526 uninjured group n = 525), including individuals with (n = 141) and without ( n = 384) limb loss or with (n = 226) and without ( n = 300) deployment-related Traumatic Brain Injury (TBI), reported medication use during a clinical interview. Overall incidence of prescribing any medication, specific anatomical/therapeutic classes (e.g., Central Nervous System (CNS), psychotropic or analgesic) and medications with pain or mental health indications were investigated. General (≥5 medications), CNS (≥5), psychotropic (≥2) and analgesic (≥2) polypharmacy was also investigated. Results Compared to the uninjured group, the injured group reported a greater prevalence of prescription medication use (17.8% vs. 29.7%), including medications acting on the CNS (8.0% vs. 17.2%), psychotropics (6.3% vs. 11.8%) and analgesics (2.2% vs. 8.6%). Prevalence of polypharmacy was very low in the cohort (0%–4.4%). Incidence Rate Ratios (IRR) and 95% confidence intervals indicated that injured personnel were currently using on average over twice as many prescription medications as those in the uninjured group (IRR 2.15 (1.66, 2.92)), including medications acting on the CNS (IRR 2.67 (1.77, 4.08)), and psychotropics (IRR 2.03 (1.27, 3.25)). Similar elevations were present in those injured with and without limb loss and especially elevated in those with deployment-related TBI. Use of psychotropics amongst personnel injured with limb loss were predominantly for non-mental health indications (e.g., sleep, pain). Conclusion Pharmacological intervention is not uncommon amongst UK Armed Forces personnel who sustained serious physical injuries, but the prevalence of polypharmacy is low. Effective prescribing practices should ensure optimal recovery whilst minimising the risk of adverse events.