A high percentage of post-9/11 veterans receiving Veterans Health Administration (VA) care were found to take concurrent prescription opioids and sedative hypnotics in a retrospective study published in Health Services Research. Although specific contributors to this high rate were not determined, the researchers found that age, marriage status, and geographic location were associated with higher rates of concurrent fills of opioid and sedative hypnotics.
Using probabilistically linked VA health care and prescription data from the Oregon Prescription Drug Monitoring Program, investigators retrospectively reviewed concurrent prescriptions (≥1 day of overlap between outpatient prescriptions) of outpatient opioid and sedative-hypnotics (ie, benzodiazepines vs nonbenzodiazepines) prescriptions in veterans who entered the military after September 11, 2001, and received VA care between 2014 and 2016 (n=19,959).
A total of 5882 veterans filled opioid or sedative-hypnotic prescriptions at VA pharmacies. Concurrent prescriptions were filled by 1036 patients at non-VA pharmacies. Concurrent VA and non-VA opioid analgesics, benzodiazepines, and nonbenzodiazepines were filled by 15.1%, 8.8%, and 4.6% of veterans, respectively. Compared with veterans age ≤35 years, those between the ages of 36 and 45 years or ≥46 years were more likely to have concurrent prescription fills (odds ratio [OR], 1.4; 95% CI, 1.2-1.6 and OR, 1.4; 95% CI, 1.2-1.7, respectively).
In addition, being married vs not married, and living in nonurban vs urban regions were associated with higher rates of concurrent prescription fills (OR, 1.2; 95% CI, 1.0-1.4 and OR, 1.5; 95% CI, 1.3-1.7, respectively). Veterans with posttraumatic stress disorder (OR, 2.1; 95% CI, 1.8-2.4), any pain (OR, 1.9; 95% CI, 1.6-2.4), back or neck pain (OR, 2.0; 95% CI, 1.7-2.4), or opioid use disorder (OR, 2.0; 95% CI, 1.5-2.5) diagnoses were more likely to have concurrent prescription fills.
The lack of generalizability of the findings to veterans of states other than Oregon represents a potential study limitation.
“Fragmentation of care between VA and non-VA systems may contribute to risk for prescription drug overdose and other adverse events,” the researchers wrote. “Linkage of VA to state prescription drug monitoring program data can help identify areas in need of further quality improvement initiatives.”
Carlson KF, Gilbert TA, Morasco BJ, et al. Linkage of VA and state prescription drug monitoring program data to examine concurrent opioid and sedative-hypnotic prescriptions among veterans [published online August 7, 2018]. Health Serv Res. doi: 10.1111/1475-6773.13025