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Trends and Regional Variation in Opioid Overdose Mortality Among Veterans Health Administration Patients, Fiscal Year 2001 to 2009

Bohnert, Amy S. B. PhD*,†; Ilgen, Mark A. PhD*,†; Trafton, Jodie A. PhD‡,§; Kerns, Robert D. PhD∥,¶; Eisenberg, Anna MPH*,†; Ganoczy, Dara MPH*; Blow, Frederic C. PhD*,†

The Clinical Journal of Pain: July 2014 - Volume 30 - Issue 7 - p 605–612
doi: 10.1097/AJP.0000000000000011
Original Articles

Objectives: Opioid-related mortality has increased in the United States in the past decade. The purpose of this study was to examine trends and regional variation in opioid prescribing and overdose rates in a national health system, the Veterans Health Administration.

Materials and Methods: Annual cohorts of Veterans Health Administration patients were identified on the basis of medical records, and overdose mortality was determined from National Death Index records. State-level prescribing and overdose rates were mapped to provide information on regional variability.

Results: There were significant increases between 2001 and 2009 in the rate of overdoses associated with nonsynthetic opioids (β=0.53, 95% confidence interval, 0.35, 0.70) and methadone (β=0.63, 95% confidence interval, 0.37, 0.90) but not synthetic/semisynthetic opioids. State-level overdose rates had a moderate correlation with the average proportion of patients in that state receiving opioids (r=0.29).

Discussion: The present study demonstrates that the increases in prescription opioid overdoses observed in the general population are also found in the patient population of a national health system and provides further evidence of the population-level association between trends in opioid prescribing and opioid overdose deaths. There is substantial regional variation in both opioid prescribing and opioid-related overdose rates, and these data can inform region-specific overdose prevention strategies and opioid policy.

*VA National Serious Mental Illness Treatment Resource and Evaluation Center, VA Center for Clinical Management Research

Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI

VA Program Evaluation and Resource Center, Palo Alto

§Department of Psychiatry and Behavioral Sciences, Stanford University Medical School, Stanford, CA

Pain Research, Informatics, Medical Comorbidities and Education Center, West Haven

Department of Psychiatry, Yale School of Medicine, New Haven, CT

Supported by the Department of Veterans Affairs Office of Mental Health Operations, and a Health Services Research and Development Service, Washington, DC (HSR&D) Career Development Award (CDA-09-204). The authors declare no conflict of interest.

Reprints: Amy S. B. Bohnert, PhD, 2800 Plymouth Road, Bldg. 16 Room 227 W, Ann Arbor, MI 48109 (e-mail:

Received December 3, 2012

Accepted August 2, 2013

© 2014 by Lippincott Williams & Wilkins