Study Suggests Greater Risk of Opioid Prescription Overlap in Veterans Using Medicare Part D–Reimbursed Pharmacies
BACKGROUND:
Pain is the most prevalent problem among Veterans, who receive pain diagnoses five times more frequently compared with the general population. Opioid analgesics are one of the most commonly used medications for pain management, with 41% of Veterans receiving long-term treatment for pain with opioids. Drug overdose death rates have tripled over the last 20 years, and overdose deaths and emergency department visits attributed to opioid analgesics also have increased. This retrospective cohort study sought to identify trends in dispensed prescriptions for opioids and the frequency of overlapping days' supply of prescriptions for opioid medications in Veterans dually eligible for VA and Medicare Part D benefits. Investigators identified a random 10% sample of male Veterans and all female Veterans age 66 and older as of January 1, 2004 and assessed prescriptions dispensed between 2005 to 2009 (n=145,889). Veterans with cancer were excluded. Overlapping days' supply of opioids was evaluated within VA, within Part D (available as of 2006), and in dual-users of VA and Part D–reimbursed pharmacies from 2007 to 2009. Factors that affected the rates of opioid prescribing overlap also were examined.
FINDINGS:
- Over the study period, there was an increasing reliance on the use of Part D–reimbursed pharmacies for opioid prescriptions among Veterans. Although opioid overlap appears to be declining within the VA healthcare system, overlap is increasing among opioid prescriptions dispensed from Medicare Part D–reimbursed pharmacies.
- Predictors for overlap included female gender, Part D enrollment, no VA medication copay, sleep disorders, psychiatric diagnoses, and substance or alcohol abuse.
- Veterans who were Hispanic, older, and had higher incomes had lower odds of overlap.
- At least one opioid was dispensed to 89% of the study participants. In 2006, after Part D implementation, 55% of opioids were dispensed by VA, decreasing to 44% in 2009.
IMPLICATIONS:
- Tools such as prescription drug-monitoring programs should be used by VA and non-VA providers to decrease opioid-related harms and misuse.
LIMITATIONS:
- Data used in this study were from 2005-2009, and much has been learned about the opioid epidemic since that time.
- Investigators had data regarding patient diagnoses, but did not evaluate health records to determine pain scores, response to analgesics, or appropriateness of the pain management regimen.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 07-165). Drs. Suda, Smith, and Stroupe are part of HSR&D's Center for Innovation for Complex Chronic Healthcare (CINCCH). Dr. Gellad is part of HSR&D's Center for Health Equity Research & Promotion (CHERP).
Suda K, Smith B, Bailey L, Gellad W, Huo Z, Burk M, Cunningham F, and Stroupe K. Opioid Dispensing and Overlap in Veterans with Non-Cancer Pain Eligible for Medicare Part D. Journal of the American Pharmacists Association. May-June 2-17;57(3):333-340.
