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Regional and Rural-Urban Variation in Opioid Prescribing in the Veterans Health Administration.
Mil Med. 2019 12 01; 184(11-12):894-900.MM

Abstract

INTRODUCTION

Opioid prescribing is heterogenous across the US, where 3- to 5-fold variation has been observed across states or other geographical units. Residents of rural areas appear to be at greater risk for opioid misuse, mortality, and high-risk prescribing. The Veterans Health Administration (VHA) provides a unique setting for examining regional and rural-urban differences in opioid prescribing, as a complement and contrast to extant literature. The objective of this study was to characterize regional variation in opioid prescribing across Veterans Health Administration (VHA) and examine differences between rural and urban veterans.

MATERIALS AND METHODS

Following IRB approval, this retrospective observational study used national administrative VHA data from 2016 to assess regional variation and rural-urban differences in schedule II opioid prescribing. The primary measure of opioid prescribing volume was morphine milligram equivalents (MME) dispensed per capita. Secondary measures included incidence, prevalence of any use, and prevalence of long-term use.

RESULTS

Among 4,928,195 patients, national VHA per capita opioid utilization in 2016 was 1,038 MME. Utilization was lowest in the Northeast (894 MME), highest in the West (1,368 MME), and higher among rural (1,306 MME) than urban (988 MME) residents (p < 0.001). Most of the difference between rural and urban veterans (318 MME) was attributable to differences in long-term opioid use (312 MME), with similar rates of short-term use.

CONCLUSION

There is substantial regional and rural-urban variation in opioid prescribing in VHA. Rural veterans receive over 30% more opioids than their urban counterparts. Further research is needed to identify and address underlying causes of these differences, which could include access barriers for non-pharmacologic treatments for chronic pain.

Authors+Show Affiliations

Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA. Veterans Rural Health Resource Center, Iowa City VA Healthcare System, Iowa City, IA. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA.Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA. Veterans Rural Health Resource Center, Iowa City VA Healthcare System, Iowa City, IA. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA. Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA.Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA. Veterans Rural Health Resource Center, Iowa City VA Healthcare System, Iowa City, IA. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

31111908

Citation

Lund, Brian C., et al. "Regional and Rural-Urban Variation in Opioid Prescribing in the Veterans Health Administration." Military Medicine, vol. 184, no. 11-12, 2019, pp. 894-900.
Lund BC, Ohl ME, Hadlandsmyth K, et al. Regional and Rural-Urban Variation in Opioid Prescribing in the Veterans Health Administration. Mil Med. 2019;184(11-12):894-900.
Lund, B. C., Ohl, M. E., Hadlandsmyth, K., & Mosher, H. J. (2019). Regional and Rural-Urban Variation in Opioid Prescribing in the Veterans Health Administration. Military Medicine, 184(11-12), 894-900. https://doi.org/10.1093/milmed/usz104
Lund BC, et al. Regional and Rural-Urban Variation in Opioid Prescribing in the Veterans Health Administration. Mil Med. 2019 12 1;184(11-12):894-900. PubMed PMID: 31111908.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Regional and Rural-Urban Variation in Opioid Prescribing in the Veterans Health Administration. AU - Lund,Brian C, AU - Ohl,Michael E, AU - Hadlandsmyth,Katherine, AU - Mosher,Hilary J, PY - 2019/01/25/received PY - 2019/03/13/revised PY - 2019/5/22/pubmed PY - 2020/8/8/medline PY - 2019/5/22/entrez KW - Veterans KW - opioids KW - pharmacoepidemiology KW - rural SP - 894 EP - 900 JF - Military medicine JO - Mil Med VL - 184 IS - 11-12 N2 - INTRODUCTION: Opioid prescribing is heterogenous across the US, where 3- to 5-fold variation has been observed across states or other geographical units. Residents of rural areas appear to be at greater risk for opioid misuse, mortality, and high-risk prescribing. The Veterans Health Administration (VHA) provides a unique setting for examining regional and rural-urban differences in opioid prescribing, as a complement and contrast to extant literature. The objective of this study was to characterize regional variation in opioid prescribing across Veterans Health Administration (VHA) and examine differences between rural and urban veterans. MATERIALS AND METHODS: Following IRB approval, this retrospective observational study used national administrative VHA data from 2016 to assess regional variation and rural-urban differences in schedule II opioid prescribing. The primary measure of opioid prescribing volume was morphine milligram equivalents (MME) dispensed per capita. Secondary measures included incidence, prevalence of any use, and prevalence of long-term use. RESULTS: Among 4,928,195 patients, national VHA per capita opioid utilization in 2016 was 1,038 MME. Utilization was lowest in the Northeast (894 MME), highest in the West (1,368 MME), and higher among rural (1,306 MME) than urban (988 MME) residents (p < 0.001). Most of the difference between rural and urban veterans (318 MME) was attributable to differences in long-term opioid use (312 MME), with similar rates of short-term use. CONCLUSION: There is substantial regional and rural-urban variation in opioid prescribing in VHA. Rural veterans receive over 30% more opioids than their urban counterparts. Further research is needed to identify and address underlying causes of these differences, which could include access barriers for non-pharmacologic treatments for chronic pain. SN - 1930-613X UR - https://www.unboundmedicine.com/medline/citation/31111908/Regional_and_Rural_Urban_Variation_in_Opioid_Prescribing_in_the_Veterans_Health_Administration_ L2 - https://academic.oup.com/milmed/article-lookup/doi/10.1093/milmed/usz104 DB - PRIME DP - Unbound Medicine ER -