Who Overdoses on Opioids at a VA Emergency Department?

Limitations

Although Utah ranked third for drug-overdose death rates in 2008 and had the highest death rate among veterans from 2001 to 2009, this review captured only overdoses among veterans treated during the study period at the George E. Wahlen VAMC ED.^5,6 The number and characteristics of veterans during this same period who were treated for overdose in other community EDs or urgent care centers throughout Utah is unknown.

The definition of opioid and BZD dose available in this study may not represent actual use of opioids or BZDs because it was based on chart review of prescription dispensing information and UDS procedures at the George E. Wahlen VAMC, and medication misuse cannot be ruled out. This study did not evaluate specific aberrant behaviors.

Conclusion

Current overdose-prevention screening efforts primarily identify patients on high-dose opioids and those with SUDD. Many veterans in this study were older than the average US victims’ age, did not have SUDD, were prescribed opioid doses not considered high risk by current guidelines, were nearer the end of their medication supply, and had UDS reflective of prescribed medications. This study suggests that any veteran with access to opioids, whether prescribed or not, is at risk for an opioid overdose. Established risk factors may aid in developing overdose-prevention programs, but prevention should not be limited to veterans with prescribed opioids and known risk factors. Clinicians should screen patients for opioid-use disorder whenever opioids are prescribed and continue to screen them throughout therapy. Broader screening for overdose risk is needed to avoid missing important opportunities for overdose prevention.

Acknowledgments

Gale Anderson, VISN 19 PBM Data Manager, performed initial data query for the study.