Receiving prescription medications from both VA and Medicare Part D was associated with a 27% higher risk for overlapping opioid and benzodiazepine prescriptions and a two times greater risk for overlapping high-dose opioids and benzodiazepines, according to findings published in Annals of Internal Medicine.
“Overlapping use of opioids and benzodiazepines is associated with increased risk for overdose. Veterans receiving medications concurrently from the U.S. Department of Veterans Affairs and Medicare may be at higher risk for such overlap,” Ron Carico, PharmD, MPH, from the VA Pittsburgh Healthcare System, and colleagues wrote.
Carico and colleagues conducted a cross-sectional study to evaluate the effect of dual use of VA and Medicare drug benefits on the receipt of overlapping opioid and benzodiazepine prescriptions. The researchers included 368,891 veterans who were enrolled in VA and Medicare Part D and filled at least two opioid prescriptions in 2013.
They measured the proportion of patients with opioid–benzodiazepine overlap defined by the Pharmacy Quality Alliance (PQA) as two or more filled prescriptions for benzodiazepines with 30 or more days of overlap with opioids, as well as the proportion of patients with high-dose opioid–benzodiazepine overlap, defined as 30 or more days of overlap with a daily opioid dose greater than 120 morphine milligram equivalents.
Data showed that 18.3% of prescriptions were from the VA only, 30.3% were from Medicare only and 51.4% were from both VA and Medicare.
More patients in the dual-use group had a PQA opioid–benzodiazepine overlap than the VA-only group (23.1% vs. 17.3%; adjusted RR = 1.27; 95% CI, 1.24-1.3) and Medicare-only group (23.1% vs. 16.5%; adjusted RR = 1.12; 95% CI, 1.1-1.14). Additionally, more patients in the dual-use group had a high-dose overlap than the VA-only group (4.7% vs. 2.3%; adjusted RR = 2.23; 95% CI, 2.1-2.36) and Medicare-only group (4.7% vs. 2.9%; adjusted RR = 1.06; 95% CI, 1.02-1.11).
The researchers noted that the more evenly split prescriptions were between Medicare and VA, the risk for opioid and benzodiazepine overlap increased.
“These findings highlight the need to enhance coordination of care across health care systems to optimize the quality and safety of prescribing,” Carico and colleagues concluded. – by Alaina Tedesco
Carico reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.