Many military veterans can get prescription opioid painkillers from both the VA and Medicare, putting them at nearly triple the risk for an overdose, new research warns.
The finding could have implications for a huge number of vets: Roughly eight in 10 VA-covered patients have additional private or public health insurance coverage. About 51 percent have Medicare, and about one-third of those receive Medicare Part D drug benefits.
But the problem may be more about poor oversight than addicted patients trying to game the system, noted study author Dr. Walid Gellad, a researcher with the VA Pittsburgh Healthcare System.
"Only in some limited circumstances -- and we don't know how many -- is this purposeful behavior by a patient to try and get additional opioids," he explained.
"I would not think of this as 'double-dipping' or 'being caught,'" Gellad added. "In some cases, receiving opioids from both systems could have happened at different times, as veterans got care in one system first, and then in another system later, or they go back and forth between VA and the private sector. In some cases, the opioids are prescribed at the same time, sometimes unintentionally, and sometimes intentionally."
Gellad and his team found that more than 3 million veterans filled at least one opioid prescription (either through the VA or another insurer) during the time period from July 2011 through December 2013.
To see how dual health insurance coverage might influence overdose risk, the team first examined the records of 215 veterans who died from an overdose between 2012 and 2013.
Their average age was 57, most (90 percent) were male and most (84 percent) were white. All had both VA and Medicare Part D health care coverage for at least six months prior to their deaths.
For comparison, the investigators also assessed opioid prescription patterns among a "control group" of more than 800 living vets of a similar age, race, health status and gender.
About 28 percent of those who had died due to an opioid overdose had obtained their meds from both the VA and through Medicare Part D. This compared with just 14 percent of the control group, the researchers found.
Still, Gellad stressed that systemic changes that curtail getting opioids from multiple sources have been implemented by the U.S. Department of Veterans Affairs since the study ended in 2013.
For example, he noted that "the VA has instituted requirements to check prescription drug monitoring programs, which should alert physicians to instances when opioids are prescribed in different systems."
But, "for this to work to reduce the risk of overdose, clinicians have to actually check, and they have to do something with the information when they find it," Gellad added.
"Ultimately, I think we will see automated alerts that will alert clinicians to a medication prescribed in one system if it, or an interacting medication, is also being prescribed in another system," Gellad said. "But for that to have an impact, it has to alert at the point of prescribing, which is not possible yet within [the] VA or outside [the] VA."
The report was
ed online March 12 in the Annals of Internal Medicine.
Dr. Carolyn Clancy, Deputy Under Secretary for Discovery, Education and Affiliate Networks with the VA in Washington, D.C., co-authored an accompanying journal editorial.
Clancy pointed out that "because of VA's existing robust and extensive patient record system, the department has had significant success in reducing opioid use and overdose risk."
The VA has been tracking problems related to dual access to medications "for some time," she said.
"That's why the department is constantly working to improve coordination with community providers," Clancy noted. "Especially through the implementation of electronic health record modernization."
And going forward, she said, the VA hopes to augment the current screening process afforded by state prescription drug monitoring programs, by "seeking to develop [its own] electronic system to automatically check all state prescription drug monitoring programs for each veteran to further improve care coordination."
Although no illnesses have yet been reported, the makers of Signature Select Avocado Chunks are issuing a product recall due to possible contamination with the listeria germ.
ReplyDeleteIn a statement issued Tuesday, Nature's Touch Frozen Foods said the recall is "based on strict precautionary measures after the company was informed by the [U.S. Food and Drug Administration] that a routine sampling program found a positive result for Listeria monocytogenes in one sample bag of the Product."
The recall involves 12-ounce bags of frozen Signature Select Avocado Chunks with a "Best Before" date of Oct 11, 2020 on the back of the package, and UPC number 2113009412 also on the back of the package, the company said.
Infection with the Listeria monocytogenes bacterium can be serious, especially for infants and small children, the elderly and people with compromised immune systems.
"Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, listeria infection can cause miscarriages and stillbirths among pregnant women," the company noted.
Consumers may have purchased the recalled avocado at any one of a number of supermarket chains, including Albertsons, Safeway, Safeway Community Markets, Carrs-Safeway, Eagle, Lucky, Pak N Save, Pavilions or Vons, the company said.
States affected include Alaska, Arizona, California, Colorado, Hawaii, Idaho, Nebraska, Nevada, New Mexico, Oregon, South Dakota, Washington, Wyoming, Texas and Utah.
"Consumers who have purchased the product should discard or return it to the place of purchase for a full refund," Nature's Touch said.