Substance Use
Opioid Overdose Deaths Among Patients with Pain or Opioid Use Disorder Diagnosis David Fink* David Fink Carol Malte Tracy Simpson Andrew Saxon Deborah Hasin
Chronic pain and opioid use disorder (OUD) are considered drivers of US overdose trends, but lack of opportunity to link mortality files to medical records that include these clinical diagnoses present challenges to comparing magnitude and trends in these relationships. The nationwide Veterans Health Administration (VHA) electronic health records (EHR) system provides a unique opportunity to study opioid overdose trends among patients with chronic pain and OUD diagnoses. Yearly cross-sectional VHA EHR data from 2005 to 2020 were linked with the US Center for Disease Control and Prevention National Death Index to determine opioid overdose death rates among VHA patients with pain or OUD diagnosis, adjusted for age, sex, race and ethnicity. From 2005 to 2020, the overall opioid overdose death rate among patients increased approximately 2.5-fold, from 16.95 to 40.90 per 100,000. In 2005, the opioid overdose death rate was ~1.5 times higher among those with than without chronic pain (21.68 vs. 13.79 per 100,000, respectively). In contrast, 2020 patients without chronic pain had higher overdose death rates than patients with chronic pain (43.77 vs. 37.91 per 100,000, respectively), largely driven by greater increases in deaths from illicit opioids (heroin or synthetic opioids). Among patients diagnosed with OUD, the opioid overdose death rate increased from 344.07 to 790.96 per 100,000 between 2005 and 2020. Among those with OUD, opioid overdose death rates involving prescription opioids remained stable between 2005 and 2020 (218.03 and 190.62, respectively), while overdose deaths rates involving illicit opioids increased 10-fold, from 77.30 to 725.51 per 100,000. VHA patients diagnosed with OUD have opioid overdose death rates substantially higher than patients with chronic pain. The VHA has successfully undertaken many initiatives to reduce prescription opioid harms; however, overdose deaths involving illicit opioids have increased substantially and remain uncontrolled.