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.

Comments are closed here.

Related Articles

VA Facing Critical Healthcare Staffing Shortages in Near Future

Replacing Retirees Hampered by Lower Salaries WASHINGTON—Oversight agencies are sounding the alarm that VA is plagued with large staffing shortages in critical areas, including physicians, registered nurses, physician assistants, psychologists and physical therapists, as well... View Article

Army Conducts First-in-Human Trial of MERS Coronavirus Vaccine

SILVER SPRING, MD—Middle East respiratory syndrome emerged first in Saudi Arabia in 2012 before spreading to several other countries, including a major outbreak in South Korea. In total, the MERS coronavirus infected more than 2,200... View Article

U.S. Medicine Recommends

More From pharmacy


MHS Pharmacies Prescribed 6,200 Naloxone Kits Under New Directive

FALLS CHURCH, VA—In June 2018, Defense Health Agency Director Raquel Bono, MD, directed all MHS pharmacies to dispense the opioid reversal agent naloxone to eligible beneficiaries and those who request it without requiring a prescription.... View Article


Oral Cancer Therapies Create Critical Demand for Pharmacists

CHICAGO—The pace of U.S. Food and Drug Administration approval of oral anticancer medications has rapidly increased, from less than one a year at the turn of the century to 10 in 2018. While patients generally... View Article


DCVAMC Acting Pharmacy Chief Ivan Cephas: ‘Caring Is the Reason’

WASHINGTON—Ivan Cephas, PharmD, the acting chief of pharmacy at the DCVAMC, would be the first to say that what he does is not above and beyond the call of duty. Despite having been awarded the... View Article


New Military Pharmacy Program Frees Patients from Long Waits

More than a dozen military treatment facility pharmacies have implemented a pilot customer service system that gives patients greater control over how they spend their time while waiting for prescriptions to be filled.


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.

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