Journal article
Regional and Rural–Urban Variation in Opioid Prescribing in the Veterans Health Administration
Military medicine, Vol.184(11-12), pp.894-900
12/01/2019
DOI: 10.1093/milmed/usz104
PMID: 31111908
Abstract
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.
Details
- Title: Subtitle
- Regional and Rural–Urban Variation in Opioid Prescribing in the Veterans Health Administration
- Creators
- Brian C Lund - 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, IAMichael E Ohl - 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, IAKatherine Hadlandsmyth - 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, IAHilary J Mosher - 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
- Resource Type
- Journal article
- Publication Details
- Military medicine, Vol.184(11-12), pp.894-900
- DOI
- 10.1093/milmed/usz104
- PMID
- 31111908
- NLM abbreviation
- Mil Med
- ISSN
- 0026-4075
- eISSN
- 1930-613X
- Grant note
- name: Veterans Health Administration (VHA) Office of Rural Health; DOI: 10.13039/100007217, name: Health Services Research and Development; name: Comprehensive Access and Delivery Research and Evaluation Center, award: CIN 13–412; name: Office of Academic Affiliations; DOI: 10.13039/100006379, name: Office of Research and Development
- Language
- English
- Date published
- 12/01/2019
- Academic Unit
- Psychiatry; Epidemiology; Anesthesia; Internal Medicine
- Record Identifier
- 9984007167802771
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