Impact of the Opioid Safety Initiative on opioid-related prescribing in veterans

Abstract

The Veterans Health Administration (VHA) designed the Opioid Safety Initiative (OSI) to help decrease opioid prescribing practices associated with adverse outcomes. Key components included disseminating a dashboard tool that aggregates electronic medical record data to audit real-time opioid-related prescribing and identifying a clinical leader at each facility to implement the tool and promote safer prescribing. This study examines changes associated with OSI implementation in October 2013 among all adult VHA patients who filled outpatient opioid prescriptions. Interrupted time series analyses controlled for baseline trends and examined data from October 2012 to September 2014 to determine the changes after OSI implementation in prescribing of high-dosage opioid regimens (total daily dosages >100 morphine equivalents [MEQ] and >200 MEQ) and concurrent benzodiazepines. Across VHA facilities nationwide, there was a decreasing trend in high-dosage opioid prescribing with 55,722 patients receiving daily opioid dosages >100 MEQ in October 2012, which decreased to 46,780 in September 2014 (16% reduction). The OSI was associated with an additional decrease, compared to pre-OSI trends, of 331 patients per month (95% confidence interval [CI] -378 to -284) receiving opioids >100 MEQ, a decrease of 164 patients per month (95% CI -186 to -142) receiving opioids >200 MEQ, and a decrease of 781 patients per month (95% CI -969 to -593) receiving concurrent benzodiazepines. Implementation of a national health care system-wide initiative was associated with reductions in outpatient prescribing of risky opioid regimens. These findings provide evidence for the potential utility of large-scale interventions to promote safer opioid prescribing.

Assessment of Opioid Prescribing Practices Before and After Implementation of a Health System Intervention to Reduce Opioid Overprescribing

“…26,27 In general, these efforts involve adoption of guidelines and monitoring of adherence with data collection. A retrospective 5-year analysis of the impact of standard statewide prescribing guidelines for ED clinicians in Ohio demonstrated a 39.7% decrease in total number of prescriptions and a 28.3% decrease in prescriptions of more than 3 days of opioids.…”

Linkage of VA and State Prescription Drug Monitoring Program Data to Examine Concurrent Opioid and Sedative‐Hypnotic Prescriptions among Veterans

“…; Gellad, Good, and Shulkin ; Lin et al. ). Opioid and benzodiazepine co‐prescribing within the VA has also decreased consistently year over year (Lin et al.…”

“…Opioid and benzodiazepine co‐prescribing within the VA has also decreased consistently year over year (Lin et al. ). However, when accounting for non‐VA prescriptions, we observed proportions of veterans receiving concurrent prescription opioids and benzodiazepines that remained consistent across years, suggesting that some veterans may be making up the difference using non‐VA providers to supplement VA prescriptions.…”

“…; Gellad, Good, and Shulkin ; Lin et al. ). However, veterans who use non‐VA health care may counter these efforts, knowingly or unknowingly, by receiving psychotropic medications from their non‐VA providers.…”

HSR Commentary: Linking VA and Non‐VA Data to Address Important US Veteran Health Services Research Issues

“…This paper is especially relevant because opioid use and misuse have become an epidemic in the United States and the VA initiated the Opioid Safety Initiative in 2014 to attempt to combat it among Veterans (Lin et al. ). Using the linked VA and OHA PDMP data afforded Carlson and colleagues the ability to address this issue among a younger, lesser‐studied population and found that more than one‐third of Veterans who received opioids or sedative‐hypnotics from the VA had also received these prescriptions from non‐VA prescribers at some point during the study period.…”