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

Veterans who received opioid prescriptions from both inside and outside the Veterans Affairs health system had two to three times the risk for fatal overdose versus those who received prescriptions from only one source.

Receiving opioid prescriptions from both the Veterans Affairs (VA) health system and Medicare Part D clinicians was independently associated with death from overdose among veterans, a study found.

Researchers from VA Pittsburgh Healthcare System sought to evaluate the association between dual-system opioid prescribing and death from prescription opioid overdose. In the study, 215 patients who died of a prescription opioid overdose in 2012 or 2013 were matched with up to four of 833 living control patients using age, sex, race/ethnicity, disability, enrollment in Medicaid or low-income subsidies, managed care enrollment, region and rurality of residence, and a medication-based measure of comorbid conditions. Findings from the nested case-control study were published by Annals of Internal Medicine on March 12.

Sixty case-patients (28%) and 117 control patients (14%) received dual-system opioid prescriptions. Dual users had significantly higher odds of death from prescription opioid overdose than those who received opioids from the VA only (odds ratio [OR], 3.53; 95% CI, 2.17 to 5.75; P<0.001) or Medicare Part D only (OR, 1.83; 95% CI, 1.20 to 2.77; P=0.005). This risk among veterans underscores the importance of care coordination, for example through prescription drug monitoring programs (PDMP), to improve opioid prescribing safety, the authors wrote.

“As options expand for VA enrollees to simultaneously receive care outside VA, it is important to recognize and respond to the threat that health care fragmentation poses to quality of care, patient safety, and health outcomes,” the researchers concluded. “This study highlights the extent of potential consequences of dual-system use, which go beyond economic costs and poor medication safety and include increased risk for death from prescription opioid overdose.”

An accompanying editorial from the Department of Veterans Affairs said, “Although addressing overdoses is imperative, it should not be the only goal. 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 PDMP data are vital.”