Overdose risk for veterans receiving opioids from multiple sources

Am J Manag Care. 2018 Nov;24(11):536-540.

Abstract

Objectives: The aim of this study was to evaluate whether veterans in Massachusetts receiving opioids and/or benzodiazepines from both Veterans Health Administration (VHA) and non-VHA pharmacies are at higher risk of adverse events compared with those receiving opioids at VHA pharmacies only.

Study design: A cohort study of veterans who filled a prescription for any Schedule II through V substance at a Massachusetts VHA pharmacy. Prescriptions were recorded in the Massachusetts Department of Public Health Chapter 55 data set.

Methods: The study sample included 16,866 veterans residing in Massachusetts, of whom 9238 (54.8%) received controlled substances from VHA pharmacies only and 7628 (45.2%) had filled prescriptions at both VHA and non-VHA pharmacies ("dual care users") between October 1, 2013, and December 31, 2015. Our primary outcomes were nonfatal opioid overdose, fatal opioid overdose, and all-cause mortality.

Results: Compared with VHA-only users, more dual care users resided in rural areas (12.6% vs 10.6%), received high-dose opioid therapy (26.3% vs 7.3%), had concurrent prescriptions of opioids and benzodiazepines (34.8% vs 8.2%), and had opioid use disorder (6.8% vs 1.6%) (P <.0001 for all). In adjusted models, dual care users had higher odds of nonfatal opioid overdose (odds ratio [OR], 1.29; 95% CI, 0.98-1.71) and all-cause mortality (OR, 1.66; 95% CI, 1.43-1.93) compared with VHA-only users. Dual care use was not associated with fatal opioid overdoses.

Conclusions: Among veterans in Massachusetts, receipt of opioids from multiple sources was associated with worse outcomes, specifically nonfatal opioid overdose and mortality. Better information sharing between VHA and non-VHA pharmacies and prescribers has the potential to improve patient safety.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / poisoning*
  • Benzodiazepines / poisoning*
  • Comorbidity
  • Drug Overdose / epidemiology*
  • Drug Overdose / mortality
  • Female
  • Humans
  • Male
  • Massachusetts
  • Mental Disorders / epidemiology
  • Mental Health
  • Middle Aged
  • Opioid-Related Disorders / epidemiology*
  • Opioid-Related Disorders / mortality
  • Pharmacies / statistics & numerical data*
  • Residence Characteristics
  • Sex Factors
  • Socioeconomic Factors
  • United States
  • United States Department of Veterans Affairs / statistics & numerical data
  • Veterans / statistics & numerical data*

Substances

  • Analgesics, Opioid
  • Benzodiazepines