Lack of coordination between health care systems associated with fatal opioid overdose

1. The authors of this nested case control study observed that veterans who received opioid prescriptions through both, the Veterans Association (VA) and Medicare Part D were at a higher risk for fatal opioid overdose compared to veterans who only used one health care system for such prescriptions.

2. The authors found that about 28% of the case patients were receiving dual opioid prescriptions from the VA and Medicare Part D health care systems.

Evidence Rating Level: 3 (Average)

Study Rundown: In the United States, many of the veterans who are enrolled in the VA health care system are also covered through the Medicare program. These participants enrolled in two systems have the option of choosing to receive prescriptions from VA or Medicare-participating providers. One of the challenges with this dual system is the potential for unsafe opioid prescribing if there is no coordination between the systems. The authors of this study evaluated the association between dual-system opioid prescribing and death from prescription opioid overdose; they found that a lack of coordination between health care systems was associated with fatal opioid overdose. One of the limitations of this study identified by the authors was the age of the data (case patients were from 2012-2013). Therefore, this data may not accurately reflect current practices. Additionally, this study only assessed prescriptions obtained within the VA and/or Medicare Part D and may not be applicable to all other health care systems.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study

In-Depth [case control study]: The authors conducted a nested case-control study, whereby 215 case patients who died of prescription opioid overdose in 2012 or 2013 were matched with 833 living control patients. Case patients were matched to controls up to a ratio of 1:4. The authors utilized multivariable conditional logistic regression to evaluate the association between the exposure and death from prescription opioid overdose. In total, 60 case patients (27.9%) and 117 control patients (14.0%) received opioid prescriptions from both the VA and Medicare Part D system within 6 months of the date of death (referred to as the index date). The authors found that dual users had higher odds of death from prescription opioids compared to those who only received the opioids from one system. The odds ratio of prescription opioid overdose from dual-system users compared to Part D was 1.83 (CI, 1.20 to 2.77; P = 0.005) and compared to VA only was 3.53 (95% CI, 2.17 to 5.75; P < 0.001).

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