Increase in Opioid Overdose Deaths among Veterans Attributed to Increased Overdoses from Heroin and Synthetic Opioids
Receipt of prescription opioids has been found to be a key risk factor for opioid overdose. VA's Opioid Safety Initiative has led to substantially decreased opioid prescribing, largely through decreased initiation of long-term prescribing rather than discontinuation of long-term prescribing. Despite substantial reductions in prescribing, opioid overdose mortality remains high. A key question is whether there has been a reduction in opioid prescriptions among individuals who have died from overdose. Further, overdose patterns in recent years have shifted from natural/semisynthetic (prescription) opioids to heroin and synthetic opioids, primarily from illicit sources. This study examined trends in VA opioid overdose rates and receipt of prescription opioids among Veterans receiving VA care who died from opioid overdose from 2010 through 2016. Using VA records linked to National Death Index data, researchers examined annual cohorts of Veterans receiving VA care by opioid overdose categories (natural/semisynthetic opioids, heroin, methadone and other synthetic opioids) for: 1) overdose rates and changes in rates and 2) receipt of a VA opioid prescription.
- The overall rate of fatal 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.
- There was a decline in methadone overdose and no significant change in natural/semisynthetic opioid overdose.
- The synthetic opioid overdose rate and heroin overdose rate increased substantially.
- Among all opioid overdose decedents, prescription opioid receipt within 3 months before death declined from 54% in 2010 to 26% in 2016.
Fatal opioid overdose rates among Veterans receiving VA care increased because of increases in heroin and synthetic opioid overdose rates. Risk of overdose from heroin and synthetic opioids may need to be considered separately from risk from prescription opioids, and prevention efforts must broaden beyond Veterans actively receiving opioids.
- This study cannot specify the causal relationship between opioid prescriptions and overdose deaths, which would require detailed information about each patient's death.
- Prescription opioids obtained outside VA are not captured by these data.
- Heroin may be particularly undercounted in mortality data because it is metabolized to morphine, a natural opioid categorized with the semisynthetics.
This study was conducted as part of ongoing surveillance in the VA Office of Mental Health and Suicide Prevention. Drs. Lin, McCarthy, and Bohnert are part of HSR&D's Center for Clinical Management Research (CCMR) in Ann Arbor, MI and Drs. Oliva and Trafton are part of HSR&D's Center for Innovation to Implementation (Ci2i) in Palo Alto, California.
Lin L, Peltzman T, McCarthy J, Oliva E, Trafton J, Bohnert A. Changing Trends in Opioid Overdose Deaths and Prescription Opioid Receipt Among Veterans. American Journal of Preventive Medicine. July 2019;57(1):106-110.