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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1012 — Opioid Prescribing and Fatal Opioid Overdose Trends in the VHA, 2000-2007

Bohnert AS (Ann Arbor HSR&D/SMITREC), Ilgen MA (Ann Arbor HSR&D/SMITREC), Ganoczy D (Ann Arbor HSR&D/SMITREC), Valenstein M (Ann Arbor HSR&D/SMITREC), McCarthy JF (Ann Arbor HSR&D/SMITREC), Blow FC (Ann Arbor HSR&D/SMITREC)

Objectives:
Fatal prescription opioid overdose rates have increased in the United States between 1999 and 2007 (the last year of available mortality data). To date, little is known regarding trends in opioid prescribing and overdose rates in healthcare systems. This study assesses trends in rates of opioid prescribing and fatal prescription opioid overdoses among individuals receiving care in the Veterans Health Administration (VHA).

Methods:
We assessed frequency of opioid prescribing using outpatient prescription data from national, annual 5% random samples of all VHA users, for fiscal years (FYs) 2000-2007 (annual sample sizes ranged from 187,738 to 256,416). We also assessed VHA fatal prescription opioid overdose rates for the entire annual cohorts of VHA users for FYs 2000-2007, with a total of 1,972 opiate overdose deaths observed. For the annual overdose rates, patients were included if they had received VHA services in that FY or the prior FY, and were still alive at the start of the FY. Vital status and cause of death were obtained from National Death Index searches. We used Poisson regression to test changes over time in the rate of opioid overdose death.

Results:
The estimated annual prevalence of opioid medication receipt among VHA patients increased each year, from 13.5% in FY00 to 17.3% in FY07. Among patients who received an opioid medication, the estimated mean number of fills per year increased from 3.6 (SD = 4.5) in FY00 to 5.0 (SD = 5.3) in FY07. The rate of opioid overdose among VHA patients increased 48% from FY00 to FY07 (Beta = 0.03, p = 0.004), and ranged from 4.4/100,000 person-years in FY01 to 6.5/100,000 person-years in FY07.

Implications:
Between FY00-07, there were consistent increases in opioid prescribing for VHA patients. Also, between FY00-07, there were substantial increases in fatal opioid overdose rates among VHA patients.

Impacts:
Although increases in opioid prescription fills may indicate enhanced treatment for pain, increased prescription rates may contribute to the observed increased incidence of fatal opioid overdoses. New policies and clinical procedures are likely needed to optimize the benefits and reduce the risks of increased opioid prescription rates.


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