Special Issue: Linking VA and Non-VA Data to Address US Veteran Health Services Issues
Linkage of VA and State Prescription Drug Monitoring Program Data to Examine Concurrent Opioid and Sedative-Hypnotic Prescriptions among Veterans
Kathleen F. Carlson M.S., Ph.D.,
Tess A. Gilbert M.H.S.,
Benjamin J. Morasco Ph.D.,
Dagan Wright Ph.D., M.S.P.H.,
Joshua Van Otterloo M.S.P.H.,
Aldona Herrndorf M.P.H.,
Lawrence J. Cook M.Stat., Ph.D.,
Corresponding Author
Kathleen F. Carlson M.S., Ph.D.
HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR
Oregon Health and Science University - Portland State University School of Public Health, Portland, OR
Address correspondence to Kathleen F. Carlson, M.S., Ph.D., HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), 3710 SW US Veterans Hospital Road, Portland, OR 97239; and Oregon Health and Science University - Portland State University School of Public Health, Portland, OR; e-mail: [email protected].Search for more papers by this authorTess A. Gilbert M.H.S.
HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR
Search for more papers by this authorBenjamin J. Morasco Ph.D.
HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR
Department of Psychiatry, Oregon Health and Science University, Portland, OR
Search for more papers by this authorDagan Wright Ph.D., M.S.P.H.
Oregon Health and Science University - Portland State University School of Public Health, Portland, OR
OCHIN, Portland, OR
Search for more papers by this authorJoshua Van Otterloo M.S.P.H.
Prescription Drug Monitoring Program, Public Health Division, Oregon Health Authority, Portland, OR
Search for more papers by this authorAldona Herrndorf M.P.H.
HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR
Search for more papers by this authorLawrence J. Cook M.Stat., Ph.D.
Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, UT
Search for more papers by this authorKathleen F. Carlson M.S., Ph.D.,
Tess A. Gilbert M.H.S.,
Benjamin J. Morasco Ph.D.,
Dagan Wright Ph.D., M.S.P.H.,
Joshua Van Otterloo M.S.P.H.,
Aldona Herrndorf M.P.H.,
Lawrence J. Cook M.Stat., Ph.D.,
Corresponding Author
Kathleen F. Carlson M.S., Ph.D.
HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR
Oregon Health and Science University - Portland State University School of Public Health, Portland, OR
Address correspondence to Kathleen F. Carlson, M.S., Ph.D., HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), 3710 SW US Veterans Hospital Road, Portland, OR 97239; and Oregon Health and Science University - Portland State University School of Public Health, Portland, OR; e-mail: [email protected].Search for more papers by this authorTess A. Gilbert M.H.S.
HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR
Search for more papers by this authorBenjamin J. Morasco Ph.D.
HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR
Department of Psychiatry, Oregon Health and Science University, Portland, OR
Search for more papers by this authorDagan Wright Ph.D., M.S.P.H.
Oregon Health and Science University - Portland State University School of Public Health, Portland, OR
OCHIN, Portland, OR
Search for more papers by this authorJoshua Van Otterloo M.S.P.H.
Prescription Drug Monitoring Program, Public Health Division, Oregon Health Authority, Portland, OR
Search for more papers by this authorAldona Herrndorf M.P.H.
HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR
Search for more papers by this authorLawrence J. Cook M.Stat., Ph.D.
Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, UT
Search for more papers by this authorAbstract
Objective
To examine the prevalence of concurrent Veterans Health Administration (VA) and non-VA prescriptions for opioids and sedative-hypnotic medications among post-9/11 veterans in Oregon.
Data Sources
VA health care and prescription data were probabilistically linked with Oregon Prescription Drug Monitoring Program (PDMP) data.
Study Design
This retrospective cohort study examined concurrent prescriptions among n = 19,959 post-9/11 veterans, by year (2014–2016) and by patient demographic and clinical characteristics. Veterans were included in the cohort for years in which they received VA outpatient care; those receiving hospice or palliative care were excluded. Concurrent prescriptions were defined as ≥1 days of overlap between outpatient prescriptions for opioids and/or sedative-hypnotics (categorized as benzodiazepines vs. non-benzodiazepines).
Principal Findings
Among 5,882 veterans who filled opioid or sedative-hypnotic prescriptions at VA pharmacies, 1,036 (17.6 percent) filled concurrent prescriptions from non-VA pharmacies. Within drug class, 15.1, 8.8, and 4.6 percent received concurrent VA and non-VA opioids, benzodiazepines, and non-benzodiazepines, respectively. Veteran demographics and clinical diagnoses were associated with the likelihood of concurrent prescriptions, as was enrollment in the Veterans Choice Program.
Conclusions
A considerable proportion of post-9/11 veterans receiving VA care in Oregon filled concurrent prescriptions for opioids and sedative-hypnotics. Fragmentation of care may contribute to prescription drug overdose risk among veterans.
Supporting Information
| Filename | Description |
|---|---|
| hesr13025-sup-0001-AppendixSA1.pdfPDF document, 1.3 MB | Appendix SA1: Author Matrix. |
| hesr13025-sup-0002-AppendixSA2.docxWord document, 27.5 KB | Appendix SA2: Characteristics of n = 19,959 Post-9/11 Veteran VA Outpatient Service Users in Oregon, by Receipt of VA Opioid or Sedative-Hypnotic Prescriptions. |
| hesr13025-sup-0003-AppendixSA3.xlsxMS Excel, 175.1 KB | Appendix SA3: International Classification of Diseases—9th Revision—Clinical Modification Codes Used to Identify Veterans’ Diagnoses of Interest. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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