title: Trends in prevalent and incident opioid receipt: an observational study in Veterans Health Administration 2004-2012.
abstract: BACKGROUND
  Improved understanding of temporal and regional trends may support safe and effective prescribing of opioids.
  
  
  OBJECTIVE
  We describe national, regional, and facility-level trends and variations in opioid receipt between fiscal years (FY) 2004 and 2012.
  
  
  METHODS
  Observational cohort study using Veterans Health Administration (VHA) administrative databases.
  
  
  METHODS
  All patients receiving primary care within 137 VHA healthcare systems during a given study year and receiving medications from VHA one year before and during a given study year.
  
  
  METHODS
  Prevalent and incident opioid receipt during each year of the study period.
  
  
  RESULTS
  The overall prevalence of opioid receipt increased from 18.9% of all veteran outpatients in FY2004 to 33.4% in FY2012, a 76.7% relative increase. In FY2012, women had higher rates of prevalent opioid receipt than men (42.4% vs. 32.9%), and the youngest veterans (18-34 years) had higher prevalent opioid receipt compared to the oldest veterans (≥ 80 years) (47.6% vs. 17.9%). All regions in the United States saw increased rates of prevalent opioid receipt during this time period. Prevalence rates varied widely by facility: in FY2012, the lowest-prescribing facility had a rate of 13.5%, and the highest of 50.8%. Annual incident opioid receipt increased from 8.8% in FY2004 to 10.2% in FY2011, with a decline to 9.8% in FY2012. Incident prescribing increased at some facilities and decreased at others. Facilities with high prevalent prescribing tended to have flat or decreasing incident prescribing rates during the study time frame.
  
  
  CONCLUSIONS
  Rates of opioid receipt increased throughout the study time frame, with wide variation in prevalent and incident rates across geographical region, sex, and age groups. Prevalence and incidence rates reflect distinct prescribing practices. Areas with the highest prevalence tended to have lower increases in incident opioid receipt over the study period. This likely reflects facility-level variations in prescribing practices as well as baseline rates of prevalent use. Future work assessing opioid prescribing should employ methodologies to account for and interpret both prevalent and incident opioid receipt.
authors.affiliation: Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA, hilary.mosher@va.gov.
authors.forename: H J
authors.initials: HJ
authors.lastname: Mosher
authors.forename: E E
authors.initials: EE
authors.lastname: Krebs
authors.forename: M
authors.initials: M
authors.lastname: Carrel
authors.forename: P J
authors.initials: PJ
authors.lastname: Kaboli
authors.forename: M W Vander
authors.initials: MW
authors.lastname: Weg
authors.forename: B C
authors.initials: BC
authors.lastname: Lund
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy*; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D016527:Drug Costs / Q000639:trends; D062787:Drug Overdose / Q000453:epidemiology / Q000503:physiopathology; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006787:Hospitals, Veterans / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011320:Primary Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000639:trends*
chemical_list: D000701:Analgesics, Opioid