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Veterans receiving opioids from multiple pharmacies faced higher risks of nonfatal overdose and death. Improving information sharing between Veterans Health Administration (VHA) and non-VHA pharmacies can enhance patient safety.

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Area of Science:

  • Public Health
  • Pharmacoepidemiology
  • Veterans Health

Background:

  • Veterans often receive care from multiple sources, including the Veterans Health Administration (VHA) and non-VHA providers.
  • Concurrent use of opioids and benzodiazepines, and high-dose opioid therapy are prevalent concerns in veteran populations.
  • Understanding the risks associated with fragmented medication access is crucial for patient safety.

Purpose of the Study:

  • To determine if veterans obtaining opioids from both VHA and non-VHA pharmacies (

Main Methods:

  • A cohort study analyzed prescription data for 16,866 Massachusetts veterans from October 2013 to December 2015.
  • Prescription data were sourced from the Massachusetts Department of Public Health Chapter 55 dataset.
  • Outcomes included nonfatal and fatal opioid overdose, and all-cause mortality.

Main Results:

  • Dual care users (VHA and non-VHA pharmacies) had higher odds of nonfatal opioid overdose (OR, 1.29) and all-cause mortality (OR, 1.66) compared to VHA-only users.
  • Dual care users were more likely to reside in rural areas, receive high-dose opioids, and have concurrent opioid and benzodiazepine prescriptions.
  • No significant association was found between dual care use and fatal opioid overdoses.

Conclusions:

  • Veterans accessing opioids from multiple sources (VHA and non-VHA) face increased risks of nonfatal overdose and mortality.
  • Enhanced information sharing between VHA and non-VHA pharmacies and prescribers is recommended to improve patient safety.
  • Fragmented care pathways for controlled substances pose significant risks to veteran health outcomes.