BACKGROUND: Opioid overdose and other related harms are a major source of morbidity and mortality among US Veterans, in part due to high-risk opioid prescribing. OBJECTIVES: We sought to determine whether having multiple sources of payment for opioids-as a marker for out-of-system access-is associated with risky opioid therapy among veterans. RESEARCH DESIGN: Cross-sectional study examining the association between multiple sources of payment and risky opioid therapy among all individuals with Veterans Health Administration (VHA) payment for opioid analgesic prescriptions in Kentucky during fiscal year 2014-2015. MEASURES: Source of payment categories: (1) VHA only source of payment (sole source); (2) sources of payment were VHA and at least 1 cash payment [VHA+cash payment(s)] whether or not there was a third source of payment; and (3) at least one other noncash source: Medicare, Medicaid, or private insurance [VHA+noncash source(s)]. Our outcomes were 2 risky opioid therapies: combination opioid/benzodiazepine therapy and high-dose opioid therapy, defined as morphine equivalent daily dose ≥90 mg. RESULTS: Of the 14,795 individuals in the analytic sample, there were 81.9% in the sole source category, 6.6% in the VHA+cash payment(s) category, and 11.5% in the VHA+noncash source(s) category. In logistic regression, controlling for age and sex, persons with multiple payment sources had significantly higher odds of each risky opioid therapy, with those in the VHA+cash having significantly higher odds than those in the VHA+noncash source(s) group. CONCLUSIONS: Prescribers should examine the prescription monitoring program as multiple payment sources increase the odds of risky opioid therapy.
BACKGROUND: Opioid overdose and other related harms are a major source of morbidity and mortality among US Veterans, in part due to high-risk opioid prescribing. OBJECTIVES: We sought to determine whether having multiple sources of payment for opioids-as a marker for out-of-system access-is associated with risky opioid therapy among veterans. RESEARCH DESIGN: Cross-sectional study examining the association between multiple sources of payment and risky opioid therapy among all individuals with Veterans Health Administration (VHA) payment for opioid analgesic prescriptions in Kentucky during fiscal year 2014-2015. MEASURES: Source of payment categories: (1) VHA only source of payment (sole source); (2) sources of payment were VHA and at least 1 cash payment [VHA+cash payment(s)] whether or not there was a third source of payment; and (3) at least one other noncash source: Medicare, Medicaid, or private insurance [VHA+noncash source(s)]. Our outcomes were 2 risky opioid therapies: combination opioid/benzodiazepine therapy and high-dose opioid therapy, defined as morphine equivalent daily dose ≥90 mg. RESULTS: Of the 14,795 individuals in the analytic sample, there were 81.9% in the sole source category, 6.6% in the VHA+cash payment(s) category, and 11.5% in the VHA+noncash source(s) category. In logistic regression, controlling for age and sex, persons with multiple payment sources had significantly higher odds of each risky opioid therapy, with those in the VHA+cash having significantly higher odds than those in the VHA+noncash source(s) group. CONCLUSIONS: Prescribers should examine the prescription monitoring program as multiple payment sources increase the odds of risky opioid therapy.
Authors: Amy K Rosen; Megan E Vanneman; William J O'Brien; Suzann Pershing; Todd H Wagner; Erin Beilstein-Wedel; Jeanie Lo; Qi Chen; Glenn C Cockerham; Michael Shwartz Journal: Health Serv Res Date: 2020-07-27 Impact factor: 3.402
Authors: Marcus A Bachhuber; Ellenie Tuazon; Michelle L Nolan; Hillary V Kunins; Denise Paone Journal: Pharmacoepidemiol Drug Saf Date: 2019-03-28 Impact factor: 2.890
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Authors: Kathleen F Carlson; Tess A Gilbert; Benjamin J Morasco; Dagan Wright; Joshua Van Otterloo; Aldona Herrndorf; Lawrence J Cook Journal: Health Serv Res Date: 2018-08-07 Impact factor: 3.402
Authors: Philip W Chui; Lori A Bastian; Eric DeRycke; Cynthia A Brandt; William C Becker; Joseph L Goulet Journal: Health Serv Res Date: 2018-10-08 Impact factor: 3.402
Authors: Ron Carico; Xinhua Zhao; Carolyn T Thorpe; Joshua M Thorpe; Florentina E Sileanu; John P Cashy; Jennifer A Hale; Maria K Mor; Thomas R Radomski; Leslie R M Hausmann; Julie M Donohue; Katie J Suda; Kevin Stroupe; Joseph T Hanlon; Chester B Good; Michael J Fine; Walid F Gellad Journal: Ann Intern Med Date: 2018-10-09 Impact factor: 25.391
Authors: Geetanjoli Banerjee; E Jennifer Edelman; Declan T Barry; Stephen Crystal; Kirsha S Gordon; Adam J Gordon; Julie R Gaither; Traci C Green; Robert D Kerns; Ajay Manhapra; Brent A Moore; David A Fiellin; Brandon D L Marshall Journal: Pain Date: 2019-09 Impact factor: 7.926