Dual Enrollment in VA and Medicare Part D Associated With Overlapping Opioid and Benzodiazepine Prescribing

Concurrent use of opioids and benzodiazepines is associated with an increased risk of overdose and guidelines recommend against co-prescribing these agents. Patients cared for in the US Veterans Health Administration (VA) often receive medications outside of the system and this can complicate management. Investigators used data from the VA and Medicare Part D to study the association between “dual use” (i.e., use of both VA and Medicare drug benefits) and receipt of overlapping prescriptions for opioids and benzodiazepines.

• In 2013, 368,891 patients received ≥2 opioid prescriptions (for a supply of ≥15 days) from the VA or Medicare Part D (18% VA-only, 30% Medicare-only, and 51% dual use).
• Of these, 102,450 (28%) received an overlapping prescription for a benzodiazepine; the rate was highest among those with dual use (31%), followed by Medicare-only (26%) and VA-only (21%).
• In adjusted analyses, those with dual use were more likely than VA-only to have an overlap (adjusted relative risk [aRR], 1.27); less so when compared with Medicare-only (aRR, 1.12). Overlap of high-dose opioids (defined as a daily morphine milligram equivalent of ≥120) and benzodiazepines was more likely among those with dual use when compared with VA-only (aRR, 2.23) and Medicare-only (aRR, 1.06).

Comments: This report shows that co-prescribing of opioids and benzodiazepines is common and that receiving care from different sources is a risk factor. It is likely that efforts to limit co-prescribing within the VA have led some to seek prescriptions from other sources. It is also possible that prescribers are more comfortable—or feel less responsible—in situations in which someone else is prescribing one of these medications. Further integration of care and health records may help to minimize this problem.

Darius A. Rastegar, MD

Reference: Carico R, Zhao X, Thorpe CT, et al. Receipt of overlapping opioid and benzodiazepine prescriptions among veterans dually enrolled in Medicare Part D and the Department of Veterans Affairs: a cross-sectional study. Ann Intern Med. 2018;169:593–602.