Veteran Opioid Overdose Deaths Are on the Rise

A recent study by the Veterans Health Administration (VHA) found that opioid overdose and associated mortality rates increased among veterans from 2010-2016.

The study, which was exempt from an institutional review board (IRB) process, included any veteran who had at least 1 VHA inpatient or outpatient interaction during the year of their death or preceding year.

Investigators did not respond to requests for comment at the time of publication.

Forms of overdose deaths were categorized by the Centers for Disease Control and Prevention (CDC) death codes, while the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) defined forms of opioids associated with veteran deaths.

The CDC codes defined unintentional, suicide, homicide, or undetermined intent of death, as well as other necessary specifications. The ICD-10 codes included natural/semisynthetic opioids, methadone, synthetic opioids other than methadone, and heroin, with intermittent overlap for multiple-opioid overdoses.

Overdose mortality rates were calculated by dividing the number of deaths by the total risk time—risk time being either from the VHA encounter to the year’s end or January 1 through the year’s end (for veterans who had VHA encounters the previous year). Rates also were adjusted to account for variance in age, sex, and race/ethnicity.

The rate of overdose deaths increased from 14.47 in 2010, to 21.08 in 2016 (adjusted rate ratio: 1.65; 95% CI: 1.51-1.81), primarily due to heroin and non-methadone synthetic opioids. Where semisynthetic/natural opioids were involved, the rates hardly changed at all, and where methadone was involved, the rates actually decreased.

The data clearly differentiated heroin and synthetic opioids as the greatest dangers, and echoes findings from a Brown University 2016 study which analyzed nearly 3400 military veterans over a decade. Investigators learned that many who misused prescription opioids eventually turned to heroin.

The new VHA study also found the rate of patients who filled an opioid prescription with 3 months of their overdose decreased from 54% in 2010 to 26% in 2016. This indicated that non-prescription opioids, which receive less attention in overdose prevention efforts, are actually harming veterans the most.

Limitations of the study included a predominantly male focus group, exclusion of veterans outside the VHA, an inability to fully quantify the causal relationship between opioid prescriptions and overdose deaths, and the fact that heroin metabolizes to morphine after a person’s death, affecting final opioid categorization. Nevertheless, the data proves a shift from the threat of prescription opioids to synthetic.

“Prescriptions of opioids declined among patients who died from all categories of opioid overdose,” investigators concluded. “By 2016, only a minority received an opioid analgesic from Veterans Health Administration within 3 months of overdose.”

The team advised that future prevention efforts extend beyond patients actively receiving opioid prescriptions, and also target at-risk populations including veterans.

The study, “Changing Trends in Opioid Overdose Deaths and Prescription Opioid Receipt Among Veterans,” was published online in the American Journal of Preventive Medicine.