Assessing Dual Prescription Receipt and Risk for Opioid Overdose Death for Veterans

Veterans who received opioid prescriptions from both the VA and Medicare Part D providers were more likely to unintentionally but fatally overdose on opioids.

Veterans dually enrolled in the United States Department of Veterans Affairs (VA) and Medicare Part D who received prescriptions for opioids from both systems appear to have 2 to 3 times the risk of unintentional prescription opioid overdose fatality compared with veterans receiving opioid prescriptions from only 1 source, according to a study published in Annals of Internal Medicine.

More than half of veterans enrolled in the VA are also covered by Medicare Part D and can choose whether to receive prescription medications from the VA or from Medicare-participating providers, which can lead to unsafe prescription use if care is not coordinated or if prescription use between systems is not tracked. The current nested case-control study was designed to identify the association between dual receipts of prescription opioids and prescription opioid overdose fatalities. Data on case and control patients were taken from dually enrolled veterans who filled at least 1 prescription for opioids from either the VA or Medicare Part D.

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The 215 veterans who died of overdose in 2012 and 2013 were matched 1:4 with living control patients (n=833) based on date of death using sex, age, race/ethnicity, region and rurality of residence, disability, enrollment in low-income subsidies or Medicaid, managed care enrollment, and comorbid conditions as measured by medication use. Exposure was opioid prescription source within 6 months of the date of death, categorized as VA only, Medicare Part D only, or dual use.

The study outcome was undetermined intent death or unintentional overdose death from prescription opioids (as identified from the National Death Index). Conditional logistic regression was used to estimate the association between outcome and prescription source, with adjustments for marital status, age, use of other medications, and prescription drug monitoring programs.

Overall, 27.9% of case patients (mean age 57.3 years, 90% men, 84% non-Hispanic white) and 14.0% of control patients received dual prescriptions for opioids. Dual users had a significantly higher risk of prescription opioid overdose death than veterans receiving opioids from only the VA (odds ratio [OR], 3.53; 95% CI, 2.17-5.75; P <.001) or only Medicare Part D (OR, 1.83; 95% CI, 1.20-2.77; P =.005).

Limitations of the study include that the data were only from 2012 to 2013 and could not capture prescriptions received from outside the VA or Medicare systems. Nevertheless, an association was found between receiving dual prescription opioids from the VA and Medicare Part D and a 2 to 3 times increased odds of unintentional prescription opioid overdose fatality.

The researchers concluded that “These results emphasize the relevance of identifying this vulnerable group of veterans and the importance of care coordination across providers and health care systems to increase the safety of opioid prescribing both inside and outside VA.”

Disclosures: Several authors report grants from the VA.


Moyo P, Zhao X, Thorpe CT, et al. Dual receipt of prescription opioids from the Department of Veterans Affairs and Medicare Part D and prescription opioid overdose death among veterans: a nested case-control study [published online March 12, 2019]. Ann Intern Med. doi: 10.7326/M18-2574

This article originally appeared on Medical Bag