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2019 HSR&D/QUERI National Conference Abstract

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1099 — Opioid-Involved Overdose Mortality in Veterans, 2010 - 2016

Lead/Presenter: Talya Peltzman,  Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC)
All Authors: Ravindran C (Center of Excellence for Suicide Prevention), Peltzman T (SMITREC and Office of Mental Health and Suicide Prevention), Morley SW (Center of Excellence for Suicide Prevention), Drexler K (Office of Mental Health and Suicide Prevention and Office of Patient Care Services), McCarthy JF (SMITREC and Office of Mental Health and Suicide Prevention)

Objectives:
In the context of rapid increases, since the early 1990s, in US opioid overdose mortality, relatively little is known regarding opioid overdose deaths among Veterans. The Department of Veterans Affairs has developed comprehensive mortality surveillance systems. Initiated for Veteran suicide surveillance, these also inform all-cause and cause-specific mortality surveillance. Here we present national surveillance findings regarding Veteran opioid overdose mortality, 2010-2016. Analyses parallel Centers for Disease Control and Prevention (CDC) assessments for the US population (Rudd et al., 2016), examining opioid overdose death counts, crude and age-adjusted rates, by year, overall and by age, sex, region and state.

Methods:
Vital status and cause of death were determined from VA/Department of Defense searches of the CDC National Death Index, per the VA Suicide Data Repository. Overdose deaths were assessed using cause of death codes X40-44, X60-64, X85 and Y10-14. Opioid specific overdose deaths were identified using multiple-cause-of-death codes T40.0-4 and T40.6. These were further categorized as heroin (T40.1); natural, semisynthetic, or other (T40.2); methadone (T40.3); and non-methadone synthetics (T40.4). Age-adjusted rates were calculated using the 2000 US population and Veteran population estimates from the VetPop2016 model. Significant changes in rates were assessed using normal Z tests or overlapping confidence intervals.

Results:
From 2010 to 2016, the Veteran population fell 10.1%, while Veteran overdose deaths rose 28.9% and Veteran opioid overdose deaths rose 56.0%. Age-adjusted overdose rates rose 48.7%, from 19.7 to 29.3/100,000, and opioid overdose rates rose 78.9%, from 10.9 to 19.5/100,000. While methadone overdose rates fell by 36.4%, from 2.2 to 1.4/100,000, rates rose 6.9% for natural/synthetic opioids overdoses, from 5.8 to 6.2/100,000; 546.7% for synthetic non-methadone overdoses, from 1.5 to 9.7/100,000; and 325% for heroin overdoses, from 1.6 to 6.8/100,000. Differences by region, state, sex, and age will be discussed.

Implications:
Veteran overdose mortality, especially involving opioids, increased substantially from 2010-2016, resembling US trends. Veterans experienced dramatic increases in synthetic non-methadone- and heroin-involved mortality. VA has prioritized opioid safety and overdose prevention.

Impacts:
National VA suicide surveillance has supported important expansion of overall Veteran mortality surveillance. This work highlights important trends in Veteran overdose and opioid-involved mortality.