IOWA CITY, IA—Rural veterans received significantly more opioid prescriptions from the VA than those in urban areas, and that could be behind some of the drug problems in less-populated areas, according to a new study.

The study in Military Medicine pointed out that opioid prescribing is extremely inconsistent across the United States. In fact, researchers from the Center for Comprehensive Access and Delivery Research and Evaluation at the Iowa City VA Healthcare System and colleagues found that a three- to fivefold variation has been observed across states or other geographical units.1

“Residents of rural areas appear to be at greater risk for opioid misuse, mortality, and high-risk prescribing,” the study authors wrote, adding the VHA “provides a unique setting for examining regional and rural–urban differences in opioid prescribing, as a complement and contrast to extant literature.”

The study’s objective was to characterize regional variation in opioid prescribing across VHA and to examine differences between rural and urban veterans.

The retrospective observational study used national administrative VHA data from 2016 to assess regional variation and rural-urban differences in Schedule II opioid prescribing. Defined as the primary measure of opioid prescribing volume was morphine milligram equivalents dispensed per capital, while incidence, prevalence of any use and prevalence of long-term use were secondary measures.

Results indicated that, among 4,928,195 patients, national VHA per capita opioid utilization in 2016 was 1,038 MME. Researchers reported that utilization was lowest in the Northeast (894 MME) and highest in the West (1,368 MME). It also was considerably higher among rural (1,306 MME) than urban (988 MME) residents (p< 0.001), they said.

Researchers emphasized that most of the difference between rural and urban veterans (318 MME) was attributable to differences in long-term opioid use (312 MME), with similar rates of short-term use.

“There is substantial regional and rural-urban variation in opioid prescribing in VHA. Rural veterans receive over 30% more opioids than their urban counterparts,” the study authors concluded. “Further research is needed to identify and address underlying causes of these differences, which could include access barriers for non-pharmacologic treatments for chronic pain.”

Lund BC, Ohl ME, Hadlandsmyth K, Mosher HJ. Regional and Rural-Urban Variation in Opioid Prescribing in the Veterans Health Administration. Mil Med. 2019 May 21. pii: usz104. doi: 10.1093/milmed/usz104. [Epub ahead of print] PubMed PMID: 31111908.