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Dual opioid prescriptions from VA, Medicare linked to higher risk for overdose death

Receiving opioid prescriptions from both the U.S. Department of Veterans Affairs and Medicare Part D was independently associated with two to three times the odds of unintentional death from an opioid overdose, according to findings published in Annals of Internal Medicine.

“More than half of enrollees in the U.S. Department of Veterans Affairs (VA) are also covered by Medicare and can choose to receive their prescriptions from VA or from Medicare-participating providers,” Patience Moyo, PhD, assistant professor of health services, policy and practice at Brown University School of Public Health, and colleagues wrote. “Such dual-system care may lead to unsafe opioid use if providers in these two systems do not coordinate care or if prescription use is not tracked between systems.”

Moyo and colleagues conducted a nested case-control to determine the association between dual-system opioid prescribing and adverse health outcomes of unsafe prescribing, such as overdose death. The researchers recruited 1,048 patients who were enrolled in VA and Medicare Part D and filled at least one opioid prescription from either system. Among those, there were 215 patients who died due to a prescription opioid overdose in 2012 or 2013 (mean age, 57.3 years; 90% men; 84% non-Hispanic white). Those patients were matched up to 1:4 with 833 living control patients (mean age, 58.3 years) based on clinical, demographic, and social factors.

The source of opioid prescriptions within 6 months of the date of death was identified for each participant and categorized as VA only, Part D only or VA and Part D. The researchers used conditional logistic regression to estimate the relationship between source of opioid prescription and unintentional or undetermined-intent death from prescription opioid overdose. Results were adjusted of age, martial status, prescription drug monitoring programs and use of other medications.

Dual opioid prescriptions from the VA and Part D were received by 28% of case patients and 14% of control patients.

The likelihood of death from prescription opioid overdose was significantly higher among dual users than those who received opioids from VA only (OR = 3.53; 95% CI, 2.17-5.75) or Part D only (OR = 1.83; 95% CI, 1.2-2.77).

“These results emphasize the relevance of identifying this vulnerable group of veterans and the importance of care coordination across providers and health care systems to increase the safety of opioid prescribing both inside and outside VA,” Moyo and colleagues concluded.

In an accompanying editorial, Laurence J. Meyer, MD, PhD, and Carolyn M. Clancy, MD, from the VA, agreed with Moyo and colleagues that it is crucial to address system issues connected with dual use.

“Although addressing overdoses is imperative, it should not be the only goal,” they wrote. “Identifying nonnarcotic alternatives for pain, reducing semiautomatic prescribing for minor procedures, and enhancing our ability to predict which patients are likely to have difficulty using opioids for a short time are also essential. Further, addressing systems issues that arise from dual use and making it easier for providers to access state prescription drug monitoring program data are vital.” – by Alaina Tedesco

Disclosures: Clancy and Meyer report no relevant financial disclosures. Moyo reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.