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August 1, 2019

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VA research in action

Data-sharing agreement to limit unsafe opioid prescribing


Photo for illustrative purposes only. (Photo: ©iStock/Hiraman)

Spurred by research showing that Veterans who receive prescriptions for pain from more than one health care system were more likely to die from an opioid overdose, in 2019 VA entered into a landmark data-sharing agreement with Medicare. The agreement gives VA the ability to monitor medical prescriptions issued outside VA through Medicare Part D on a national scale, which will directly impact care coordination and improve opioid safety for Veterans.

More than half of VA patients have chronic pain, and many receive opioid medications. VA has several initiatives in place to monitor prescription opioids and related medications to ensure their safe use. But these efforts focus almost entirely on monitoring prescriptions within VA. However, more than 75% of Veterans have other forms of health insurance and can access prescriptions, including opioids, in non-VA settings, including through Medicare.

Researchers studied the impact of dual use of VA and Medicare prescription benefits on opioid safety for Veterans. In a national cohort of a half-million Veterans, 71,146 (13%) received opioid prescriptions from both VA and Medicare, including 23,107 (32%) who had at least 30 days of overlapping opioid prescriptions. Dual use was associated with three times the risk of high-dose opioid exposure and twice the risk of exposure lasting more than 90 days, compared with VA-only use. Dual-use Veterans had a 27% higher risk of receiving overlapping opioid and benzodiazepine prescriptions (an unsafe combination) than VA-only Veterans. Finally, the risk of death from prescription opioid overdose was three times higher in dual-use Veterans, compared with Veterans using only VA.

Principal investigator: Dr. Walid Gellad, Pittsburgh VA Healthcare System

Selected publications:

Dual receipt of prescription opioids from the Department of Veterans Affairs and Medicare Part D and prescription opioid overdose death among Veterans: A nested care-control study. Moyo P, Thorpe CT, Thorpe JM, Sileanu FE, Cashy JP, Hale JA, Mor MK, Radomski TR, Donohue JM, Hausmann LR, Hanlon JT, Good CB, Fine MJ, Gellad WF. Annals of Internal Medicine. 2019 April 2;170(7):433-442.

Impact of dual use of Department of Veterans Affairs and Medicare Part D drug benefits on potentially unsafe opioid use. Gellad WF, Thorpe JM, Zhao X, Thorpe CT, Sileanu FE, Cashy JP, Hale JA, Mor MK, Radomski TR, Hausmann LR, Donohue JM, Gordon AJ, Suda KJ, Stroupe KT, Hanlon JT, Cunningham FE, Good CB, Fine MJ. Am J Public Health. 2018 Feb;108(2):248-255.

Association between dual use of Department of Veterans Affairs and Medicare Part D drug benefits and potentially unsafe prescribing. Thorpe JM, Thorpe CT, Schleiden L, Cashy J, Carico R, Gellad WF, Van Houtven CH. JAMA Intern Med. 2019 Jul 22.

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