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Changing Trends in Opioid Overdose Deaths and Prescription Opioid Receipt Among Veterans

  • Lewei (Allison) Lin
    Correspondence
    Address correspondence to: Lewei (Allison) Lin, MD, MS, University of Michigan and VA Ann Arbor Healthcare System, Building 16, 2nd Floor, 2800 Plymouth Road, Ann Arbor MI 48109.
    Affiliations
    Department of Psychiatry, University of Michigan, Ann Arbor, Michigan

    Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
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  • Talya Peltzman
    Affiliations
    Serious Mental Illness Treatment Resource and Evaluation Center, VA Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan
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  • John F. McCarthy
    Affiliations
    Department of Psychiatry, University of Michigan, Ann Arbor, Michigan

    Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan

    Serious Mental Illness Treatment Resource and Evaluation Center, VA Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan
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  • Elizabeth M. Oliva
    Affiliations
    Program Evaluation and Resource Center, VA Office of Mental Health and Suicide Prevention, Menlo Park, California

    Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
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  • Jodie A. Trafton
    Affiliations
    Program Evaluation and Resource Center, VA Office of Mental Health and Suicide Prevention, Menlo Park, California

    Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
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  • Amy S.B. Bohnert
    Affiliations
    Department of Psychiatry, University of Michigan, Ann Arbor, Michigan

    Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
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      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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