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Study Identifies Safety Risk for Veterans Receiving Overlapping Buprenorphine, Opioid, and Benzodiazepine Prescriptions from VA and Medicare Part D


BACKGROUND: Although buprenorphine has emerged as a key tool in the management of opioid use disorder, there are growing concerns about abuse and diversion, thus buprenorphine is not typically co-prescribed with other opioids for more than a short period of time. Similarly, the co-administration of buprenorphine with benzodiazepines is often discouraged, given an increased risk of adverse events. Ensuring safe buprenorphine prescribing is especially challenging for VA, which treats a substantial number of Veterans with chronic pain and opioid use disorder, as well as an increasing number of patients who receive concurrent care in the private sector (i.e., Medicare Part D). This study identified 1,790 Veterans dually enrolled in VA and Medicare Part D who filled a buprenorphine prescription in 2012, including 760 (43%) filling from VA and 1,091 (61%) from Medicare. Investigators then determined the proportion of Veterans that received any overlapping prescription for a non-buprenorphine opioid or benzodiazepine from a different system than their buprenorphine prescription (Part D buprenorphine recipients receiving overlapping opioids or benzodiazepines from VA and vice versa).

FINDINGS:

  • More than one in four Veterans who received a VA prescription for buprenorphine – and one in five Veterans who received a Medicare prescription for buprenorphine – also received overlapping prescriptions for opioids from a different healthcare system.
    • Among Veterans who received their buprenorphine prescription from VA, 199 (26%) received an overlapping opioid prescription from Part D. Among those who received buprenorphine from Medicare, 208 (19%) also received an opioid prescription from VA.
  • Among Veterans receiving buprenorphine from VA, 11 (1%) received an overlapping benzodiazepine prescription from Medicare, while among those receiving buprenorphine from Medicare, 178 (16%) received an overlapping benzodiazepine prescription from VA.
  • Among VA and Part D buprenorphine recipients who had cross-system opioid overlap, 25% (49/199) and 35% (72/208), respectively, had >90 days of overlap.

IMPLICATIONS:

  • Findings indicate a previously undocumented safety risk for Veterans dually enrolled in VA and Medicare who are receiving prescriptions for buprenorphine and overlapping prescriptions for opioids and/or benzodiazepines. This is important as both VA and Medicare seek to expand buprenorphine treatment for substance use disorder.

LIMITATIONS:

  • Data are from 2012 and do not necessarily represent the current state of buprenorphine use.
  • Investigators were unable to identify whether overlapping prescriptions are clinically justified.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 14-297). All authors are part of HSR&D's Center for Health Equity Research & Promotion (CHERP), in Pittsburgh, PA.


PubMed Logo Gellad W, Zhao X, Thorpe C, et al. Overlapping Buprenorphine, Opioid, and Benzodiazepine Prescriptions among Veterans Dually Enrolled in VA and Medicare Part D. Substance Abuse. December 7, 2016:e-pub ahead of print.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.