Dual-system opioid prescribing tied to overdose deaths

  • Moyo P & al.
  • Ann Intern Med
  • 12.03.2019

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Veterans enrolled in both the Veterans Administration (VA) health system and Medicare Part D who receive opioids from both sources are 2 to 3 times more likely to die from an unintentional opioid overdose than those who received opioids from a VA or non-VA provider alone.

Why this matters

  • Many VA enrollees use both VA and non-VA providers, a dual-system care approach that complicates the monitoring of potential unsafe opioid use.

Study design

  • This nested case-control study evaluated all veterans enrolled in VA health system and Medicare Part D who filled ≥1 opioid prescription from either system.
  • 215 case patients who died of a prescription opioid overdose in 2012 or 2013 were matched with 833 living control patients.
  • Funding: US Department of Veterans Affairs.

Key results

  • Dual users (aOR, 3.53; P<.001 or part d only users p>=.002) vs those who received opioids from VA only had significantly higher odds of death from prescription opioid overdose.
  • Dual users vs part D only users had significantly higher odds of death from prescription opioid overdose (aOR, 1.83; P=.005).

Limitations

  • Reliance on death certificate data.
  • Findings not generalizable to patients whose overdose deaths were intentional or a result of illicit opioids.

Coauthored with Antara Ghosh, PhD