title: Outpatient Provider Contact Prior to Unintentional Opioid Overdose Among VHA Service Users.
abstract: OBJECTIVE
  Prescription opioid medications are the most commonly implicated substances in unintentional overdoses. Outpatient health care encounters represent a potential opportunity to intervene to reduce opioid overdose risk. This study assessed the timing and type of outpatient provider contacts prior to death from unintentional prescription opioid overdose.
  
  
  METHODS
  This study examined all adult patients nationally in the Veterans Health Administration (VHA) who died from unintentional prescription opioid overdose in fiscal years 2004-2007 and who used VHA services anytime within two years of their deaths (N=1,813). For those whose final treatment contact was in an outpatient setting (N=1,457), demographic, clinical, and treatment characteristics were compared among patients categorized by the location of their last contact.
  
  
  RESULTS
  Among individuals last seen in outpatient settings, 33% were seen within one week of their overdose and 62% within one month of their overdose. A substantial proportion of patients (30%) were last seen within one month of death in mental health or substance use disorder outpatient settings. The majority of patients (86%) did not fill an opioid prescription on their last outpatient visit prior to death from unintentional opioid overdose.
  
  
  CONCLUSIONS
  Most patients who died by unintentional prescription opioid overdose were seen in outpatient settings within a month of their overdose. These settings may provide an opportunity to prevent patients from dying from prescription opioid overdoses. Interventions to reduce risk should not be limited to visits during which an opioid is prescribed.
authors.affiliation: The authors are affiliated with the Department of Psychiatry, University of Michigan, and with the Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan (e-mail: leweil@med.umich.edu ).
authors.forename: Lewei Allison
authors.initials: LA
authors.lastname: Lin
authors.affiliation: The authors are affiliated with the Department of Psychiatry, University of Michigan, and with the Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan (e-mail: leweil@med.umich.edu ).
authors.forename: Amy S B
authors.initials: AS
authors.lastname: Bohnert
authors.affiliation: The authors are affiliated with the Department of Psychiatry, University of Michigan, and with the Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan (e-mail: leweil@med.umich.edu ).
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ilgen
authors.affiliation: The authors are affiliated with the Department of Psychiatry, University of Michigan, and with the Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan (e-mail: leweil@med.umich.edu ).
authors.forename: Paul N
authors.initials: PN
authors.lastname: Pfeiffer
authors.affiliation: The authors are affiliated with the Department of Psychiatry, University of Michigan, and with the Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan (e-mail: leweil@med.umich.edu ).
authors.forename: Dara
authors.initials: D
authors.lastname: Ganoczy
authors.affiliation: The authors are affiliated with the Department of Psychiatry, University of Michigan, and with the Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan (e-mail: leweil@med.umich.edu ).
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D002423:Cause of Death; D016208:Databases, Factual; D062787:Drug Overdose / Q000401:mortality*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012307:Risk Factors; D013997:Time Factors; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid