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Fragmented medical care can frustrate and confuse patients; a big problem is the pharmaceutical chaos that can occur when more than one physician prescribes medications. For opioid-dependent patients, such chaos can result in catastrophe.
Researchers examined governmental databases for Veterans Affairs (VA) patients who also were enrolled in Medicare part D and who received opioid prescriptions from either system between 2011 through 2013. Among more than 3 million such patients, 215 who were receiving regular opioid prescriptions and who died of unintentional opioid overdoses were significantly more likely to have received opioids from both insurers than were 833 matched controls. Compared with veterans who used only VA pharmacy benefits or only Medicare part D benefits, dual users had two- to fourfold greater adjusted risk for fatal overdose. Not surprisingly, overdose patients who filled prescriptions from both systems received far higher daily and cumulative doses than did controls who filled prescriptions from both systems.
Moyo P et al. Dual receipt of prescription opioids from the Department of Veterans Affairs and Medicare Part D and prescription opioid overdose death among veterans: A nested case-control study. Ann Intern Med 2019 Mar 12; [e-pub]. (https://doi.org/10.7326/M18-2574)
Meyer LJ and Clancy CM.Care fragmentation and prescription opioids. Ann Intern Med 2019 Mar 12; [e-pub]. (https://doi.org/10.7326/M19-0492)
Comment
Poor communication among clinicians can result in a bonanza of opioids for patients, sometimes with tragic results. Access to a state's Prescription Drug Monitoring Program (PDMP), which discloses all controlled substances filled for an individual patient, often illuminates a patient's prescription habits, but PDMPs sometimes don't include VA prescriptions, and their information seldom is available to clinicians in other states. Editorialists call for broader information exchange between government and private payers, in the name of patient safety.