1077 — Concurrent VA and non-VA Prescriptions among Post-9/11 Veterans Receiving Long-term Opioid Therapy

Lead/Presenter: Kathleen Carlson, COIN - Portland
All Authors: Carlson KF (HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Portland, OR) Gilbert T (HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Portland, OR) Cook LJ (University of Utah Department of Pediatrics, Division of Critical Care, Salt Lake City, UT) Mastarone G (HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Portland, OR) Morasco B (HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Portland, OR)

Objectives:
Veterans who use VA healthcare have twice the risk of fatal prescription drug overdose than non-Veterans. The majority of overdoses are associated with opioid analgesics. Risk of overdose may be increased when opioids and benzodiazepines are combined. The purpose of this study was to examine non-VA opioid and/or benzodiazepine prescriptions among post-9/11 Veterans receiving long-term opioid therapy (LTOT) through the VA.

Methods:
We used Prescription Drug Monitoring Program (PDMP) data from a single state (Oregon) to identify non-VA prescriptions among VA users. VA healthcare and prescription drug data for n = 23,065 post-9/11 Veteran VA users in Oregon were probabilistically linked to PDMP data from 2011-2016. Among Veterans receiving LTOT from the VA, we then calculated the proportions receiving non-VA prescriptions for opioids and/or benzodiazepines within the same calendar year. Non-VA prescriptions were also examined among Veterans receiving both LTOT and benzodiazepines from the VA.

Results:
Between 2011 and 2016, n = 1,606 Veterans received LTOT through the VA; of these, 38% also received non-VA opioid prescriptions, and 10% received non-VA benzodiazepine prescriptions. Proportions receiving concurrent non-VA opioid prescriptions tended to increase slightly from 2011 to 2016, while proportions receiving concurrent benzodiazepine prescriptions tended to remain the same. In the same time period, n = 605 Veterans received both LTOT and benzodiazepines within the VA; 36% concurrently received non-VA opioid and/or benzodiazepine prescriptions.

Implications:
The prevalence of concurrent VA and non-VA prescriptions among Veterans receiving LTOT from the VA was relatively high, with some Veterans receiving potentially high-risk combinations of medications from VA and non-VA prescribers. Future work will examine characteristics of Veterans associated with concurrent VA and non-VA prescription use.

Impacts:
The VA is currently implementing a new policy requiring state PDMP queries prior to the prescription of new controlled medications and -- for continuation of therapy -- at least annually and/or at the time of each renewal. Our work can help inform initiatives to increase rates of compliance with this new policy.