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2019 HSR&D/QUERI National Conference Abstract

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1056 — Changing trends in opioid overdose deaths and prescription opioid receipt among Veterans

Lead/Presenter: Lewei (Allison) Lin,  COIN - Ann Arbor
All Authors: Lin L (Center for Clinical Management Research, VA Ann Arbor Healthcare System), Peltzman T(Serious Mental Illness Treatment Resource and Evaluation Center, VA Office of Mental Health and Suicide Prevention), McCarthy JF(Center for Clinical Management Research VA Ann Arbor Healthcare System and Serious Mental Illness Treatment Resource and Evaluation Center, VA Office of Mental Health and Suicide Prevention) Oliva EM (Program Evaluation and Resource Center, VA Office of Mental Health and Suicide Prevention and Center for Innovation to Implementation, VA Palo Alto Health Care System) Trafton JA (Program Evaluation and Resource Center, VA Office of Mental Health and Suicide Prevention and Center for Innovation to Implementation, VA Palo Alto Health Care System) Bohnert AS (Center for Clinical Management Research VA Ann Arbor Healthcare System)

Objectives:
To inform opioid overdose prevention efforts, this study assessed both recent trends in opioid overdose mortality across opioid categories and receipt of prescription opioids among Veterans who died from overdose in the Veterans Health Administration (VHA).

Methods:
Using VHA records linked to National Death Index data, annual cohorts (2010-2016) of Veterans who received VHA 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) VHA prescription opioid receipt.

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 [ARR] = 1.65, 95% CI:1.51-1.81). There was a decline in methadone overdose (ARR = 0.66 95% CI:0.51-0.84) and no significant change in natural/semisynthetic opioid overdose (ARR = 1.08 95% CI:0.94-1.24). However, the synthetic opioid overdose rate (ARR = 5.46, 95% CI:4.41-6.75) and heroin overdose rate (ARR = 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.

Implications:
Opioid overdose rates among VHA Veterans increased substantially due to increases in heroin and synthetic opioid overdose rates. VHA prescriptions of opioids declined among patients who died from all categories of opioid overdose; by 2016, only a minority received an opioid analgesic from VHA within 3 months of overdose.

Impacts:
This study presents recent trends in both overdose mortality and opioid prescribing, which have implications for Veteran overdose prevention. Given that only a third of patients filled opioids within 3 months prior to death, overdose prevention efforts must broaden beyond patients actively receiving opioids. In addition, although the VHA has implemented numerous important efforts including Overdose Education and Naloxone Distribution and the Opioid Safety Initiative, additional efforts are needed for preventing opioid overdose, including further increasing medication treatment for patients with opioid use disorders.