VA Research Wrap Up: Opioid overdoses, atherosclerosis, lung cancer

VA's Office of Research and Development recently published three News Briefs on findings that touch on opioid safety, heart disease and lung cancer treatment. Each comes from research conducted by VA investigators and involves conditions that many disabled veterans live with or are at risk for. None of the three changes a benefit or a rule, but together they offer useful information to bring into conversations with a VA care team.

The first study, from researchers at VA Connecticut and Bedford, Massachusetts, looked at veterans on long-term opioid therapy for pain. It found that those showing signs of cognitive impairment were at nearly six times higher risk of an opioid overdose. The study included more than 55,000 veterans prescribed opioids, and 3% of them had documented neurocognitive symptoms such as trouble with attention, memory and executive functioning. The average time from the onset of those symptoms to an overdose was five months. The authors concluded that cognitive screening should be part of opioid safety assessments.

This matters because chronic pain is common among service-connected veterans, and long-term opioid prescriptions are part of some treatment plans. Memory and attention problems can come from many sources, including traumatic brain injury, PTSD, sleep problems, medication effects and aging, and they can make it harder to follow a dosing schedule safely. Veterans on long-term opioids, and family members who help them, should know that new or worsening difficulty with memory or focus is worth reporting promptly. The study does not say opioids should be stopped, and no one should change a prescribed regimen without talking to their prescriber.

The second brief covers laboratory work by VA researchers at the Harry S. Truman Memorial Veterans' Hospital in Columbia, Missouri. They found that a protein called olfactomedin 2, or Olfm2, is critical to the development of atherosclerosis, the buildup of plaque in the arteries. In a mouse model, Olfm2 was increased in atherosclerotic lesions and drove smooth muscle cells in arteries to become foam cells, which absorb fats and form plaques that impede blood flow. Blocking Olfm2 led to fewer plaques. The researchers suggest that medications targeting Olfm2 expression could eventually be used to prevent or treat the disease. This is early research in mice, so it is not a treatment available to patients, and no timeline was given.

The third brief comes from VA St. Louis researchers and concerns early-stage lung cancer. Among 2,234 veterans with stage 1 non-small cell lung cancer, 37.7% had cancer cells that spread through their air spaces beyond the main tumor. In those veterans, lobar resection, which removes a full lobe of the lung, was linked to a five-year survival rate above 90%. Sub-lobar resection, which removes smaller sections, was linked to survival of 73% to 80%. Adding chemotherapy after surgery did not significantly improve survival in these patients.

For disabled veterans, these findings fit a larger picture. Veterans exposed to burn pits, asbestos or other hazards during service may have lung concerns, and cardiovascular disease and chronic pain are widespread in the veteran community. Research like this shapes how VA clinicians screen, prescribe and treat over time. It is also a reminder that these are observational findings; surgical decisions depend on each patient's overall health, tumor characteristics and lung function, which only a treating team can weigh.

The practical takeaway is to use the information as a starting point for conversation. If you take long-term opioids, ask your VA provider whether cognitive screening is part of your safety review, and make sure a family member knows the warning signs of overdose. If you have been diagnosed with early-stage lung cancer, ask your surgical team how the type of operation might affect your outlook. If you are filing or updating a disability claim related to any of these conditions, your accredited Veterans Service Organization representative can help you document your diagnosis and treatment. Veterans can also find more research updates through VA's Office of Research and Development.