Introduction
To inform overdose prevention, this study assessed both recent trends in opioid overdose
mortality across opioid categories and receipt of prescription opioid analgesics among
Veterans who died from overdose in the Veterans Health Administration.
Methods
Using Veterans Health Administration records linked to National Death Index data,
annual cohorts (2010–2016) of Veterans who received Veterans Health Administration
care were obtained and were examined by opioid overdose categories (natural/semisynthetic
opioids, heroin, methadone, and other synthetic opioids) on (1) overdose rates and
changes in rates adjusted for age, sex, and race/ethnicity; and (2) Veterans Health
Administration prescription opioid receipt. Analyses were conducted in 2018.
Results
The overall rate of opioid overdose among Veterans increased from 14.47 per 100,000
person-years in 2010 to 21.08 per 100,000 person-years in 2016 (adjusted rate ratio=1.65,
95% CI=1.51, 1.81). There was a decline in methadone overdose (adjusted rate ratio=0.66,
95% CI=0.51, 0.84) and no significant change in natural/semisynthetic opioid overdose
(adjusted rate ratio=1.08, 95% CI=0.94, 1.24). However, the synthetic opioid overdose
rate (adjusted rate ratio=5.46, 95% CI=4.41, 6.75) and heroin overdose rate (adjusted
rate ratio=4.91, 95% CI=3.92, 6.15) increased substantially. Among all opioid overdose
decedents, prescription opioid receipt within 3 months before death declined from
54% in 2010 to 26% in 2016.
Conclusions
Opioid overdose rates among Veterans Health Administration Veterans increased because
of increases in heroin and synthetic opioid overdose rates. Prescriptions of opioids
declined among patients who died from all categories of opioid overdose; by 2016,
only a minority received an opioid analgesic from Veterans Health Administration within
3 months of overdose. Future prevention efforts should extend beyond patients actively
receiving opioid prescriptions.
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Article info
Publication history
Published online: May 22, 2019
Identification
Copyright
Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
