Veterans at Higher Risk of Overdose/Suicide Death after Stopping Opioid Treatment

February 1, 2021

Takeaway: HSR&D investigator Dr. Elizabeth Oliva led a study that showed Veterans were at higher risk of overdose/suicide death after stopping opioid treatment, with increasing risk the longer they had been treated before stopping. In addition, Dr. Oliva is Coordinator of VA’s National Opioid Overdose Education and Naloxone Distribution (OEND) program that distributes the now widely adopted overdose prevention drug Naloxone, commonly known as Narcan. The agency also launched the Rapid Naloxone Initiative, which has resulted in nearly 1,600 potentially lethal overdoses being prevented by the timely distribution of Naloxone to Veterans.

A study led by Dr. Elizabeth Oliva examined the associations between stopping outpatient opioid treatment, length of opioid treatment, and overdose/suicide death among VA patients. Focusing on the early implementation period of VA’s opioid safety initiative, investigators used VA data to identify Veterans with any outpatient opioid analgesic prescription during FY2013 (n=1,394,089), as well as mortality rates due to overdose or suicide through FY2014. Length of opioid treatment was categorized as ≤30 days, 31-90 days, 91-400 days, and >400 days. Findings showed:

• Patients were at higher risk of overdose/suicide death after stopping opioid treatment with increasing risk the longer they had been treated before stopping.
• The following factors also were independently associated with a higher risk for overdose/suicide death: receiving prescriptions for long-acting or short-acting opioids compared to tramadol; maximum daily morphine milligram equivalents; number of medical diagnoses; and having a mental health disorder diagnosis or substance use disorder diagnosis.

Findings indicate that opioid safety efforts should take a broader patient safety perspective and consider risk mitigation from a patient-centered perspective. This includes addressing patient risk factors other than opioid prescriptions that place patients at risk for overdose/suicide after opioid initiation and cessation, especially in the first three months post-initiation and post-cessation.

Impacts

Early study results were communicated to the FDA, VA clinicians were provided education to maintain monitoring and engagement of patients in care subsequent to opioid cessation via the National Pain Office, and Office of Mental Health and Suicide Prevention, and clinical decision support tools (e.g., STORM) were revised to enable population management of patients subsequent to opioid cessation.

Further, Dr. Oliva is Coordinator of VA’s National Opioid Overdose Education and Naloxone Distribution (OEND), which distributes the now widely adopted overdose prevention drug Naloxone, commonly known as Narcan®. The agency also launched the Rapid Naloxone Initiative, which, as of December 2019, resulted in nearly 1,000 potentially lethal overdoses being prevented by the timely distribution of Naloxone to Veterans – and, as of December 2020, is up to more than 1,600 reported opioid overdose reversals.

CITATION:  Oliva E, Bowe T, Manhapra A, et al. Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US Veterans: observational evaluation. British Medical Journal. March 4, 2020;368:m283. Doi:10.1136.