Non-Clinical Topics

Use of Non-VHA Pharmacies Increases Risks of Scheduled Drug Overdoses

by U.S. Medicine

January 15, 2019

BEDFORD, MA—Using multiple sources to get prescribed pain medications and other Schedule II through V drugs increases risks for veterans, a new study finds.

A report in the American Journal of Managed Care discussed the results of a study to evaluate whether veterans in Massachusetts receiving opioids and/or benzodiazepines from both VHA and non-VHA pharmacies are at higher risk of adverse events compared with those receiving opioids at VHA pharmacies only.1

Researchers from the Center for Healthcare Organization and Implementation Research at the Bedford VA Medical Center focused on a cohort of veterans who filled a prescription for any Schedule II through V substance at a Massachusetts VHA pharmacy. Prescriptions were recorded in the Massachusetts Department of Public Health Chapter 55 data set.

Included in the study sample were 16,866 veterans residing in Massachusetts, of whom 9,238 (54.8%) received controlled substances from VHA pharmacies only and 7,628 (45.2%) had filled prescriptions at both VHA and non-VHA pharmacies—designed as “dual care users”—between Oct. 1, 2013, and Dec. 31, 2015. Defined as the primary outcomes were nonfatal opioid overdose, fatal opioid overdose  and all-cause mortality.

The groups had some differences, researchers pointed out. Compared with VHA-only users, more dual care users:

  • Resided in rural areas (12.6% vs. 10.6%),
  • Received high-dose opioid therapy (26.3% vs. 7.3%),
  • Had concurrent prescriptions of opioids and benzodiazepines (34.8% vs. 8.2%), and
  • Had opioid use disorder (6.8% vs. 1.6%).

Results based on adjusted models indicated that dual care users had higher odds of nonfatal opioid overdose (odds ratio [OR], 1.29; 95% CI, 0.98-1.71) and all-cause mortality (OR, 1.66; 95% CI, 1.43-1.93) compared with VHA-only users. The study team noted that dual care use was not associated with fatal opioid overdoses, however.

“Among veterans in Massachusetts, receipt of opioids from multiple sources was associated with worse outcomes, specifically nonfatal opioid overdose and mortality,” study authors concluded. “Better information sharing between VHA and non-VHA pharmacies and prescribers has the potential to improve patient safety.”

Jasuja GK, Ameli O, Miller DR, Land T, Bernson D, Rose AJ, Berlowitz DR, Smelson DA. Overdose risk for veterans receiving opioids from multiple sources. Am J Manag Care. 2018 Nov;24(11):536-540. PubMed PMID: 30452210.

Related Articles

VA Overall Appointment Wait Times Shorter than the Private-Sector

Despite intense scrutiny of wait times for veterans seeking VA care over the last three years, a new study pointed out that delays in the private sector weren’t statistically less in 2014 and that, possibly because of the focus, wait times now are significantly shorter for the VA compared to private-sector healthcare facilities.

Senate Blocks Agent Orange Exposure Extension to Blue Water Veterans

Blue Water Navy veterans who claim to be impacted by toxic exposure while serving off the coast of Vietnam were forced to grapple with disappointment once again as the 115th Congress ended without passing legislation addressing their VA benefits.

U.S. Medicine Recommends

More From pharmacy


New Venous Thromboembolism Guidelines Could Change Treatment at VA

Venous thromboembolism, which includes deep venous thrombosis and pulmonary embolism, is the most common preventable cause of hospital death, according to the VA.


Shared Antimicrobial Stewardship Surveillance System Saves Three VAMCs $2.3 Million

Three VAMCs that formed a collaborative group to optimize use of a shared clinical surveillance system saved more than $2.3 million in two years.


PhARMD Program Continues to Expand Pharmacists' Clinical Role in VA

A tool developed by the VA has raised the profile of pharmacists as critical members of patient care teams at the VA, leading to a doubling of the number of pharmacists serving as providers.


Is It Time to Abandon One-Size-Fits-All Dosing for Antibiotics?

Increased obesity among veterans and the general population might be leading to more hospitalizations for infections and greater instance of failed treatment in patients who have been hospitalized.


VA Evaluates Form to Improve Function in Medication Labels

When time is of the essence, good design saves lives. That was the lesson of a recent experiment in Pittsburgh that tested whether anesthetist trainees would grab the right medication in a stressful simulated operating room scenario or make a potentially fatal mistake.

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up