title: Overlapping buprenorphine, opioid, and benzodiazepine prescriptions among veterans dually enrolled in Department of Veterans Affairs and Medicare Part D.
abstract: Buprenorphine is a key tool in the management of opioid use disorder, but there are growing concerns about abuse, diversion, and safety. These concerns are amplified for the Department of Veterans Affairs (VA), whose patients may receive care concurrently from multiple prescribers within and outside VA. To illustrate the extent of this challenge, we examined overlapping prescriptions for buprenorphine, opioids, and benzodiazepines among veterans dually enrolled in VA and Medicare Part D.
  
  
  
  We constructed a cohort of all veterans dually enrolled in VA and Part D who filled an opioid prescription in 2012. We identified patients who received tablet or film buprenorphine products from either source. We calculated the proportion of buprenorphine recipients with any overlapping prescription (based on days supply) for a nonbuprenorphine opioid or benzodiazepine, focusing on veterans who received overlapping prescriptions from a different system than their buprenorphine prescription (Part D buprenorphine recipients receiving overlapping opioids or benzodiazepines from VA and vice versa).
  
  
  
  There were 1790 dually enrolled veterans with buprenorphine prescriptions, including 760 (43%) from VA and 1091 (61%) from Part D (61 veterans with buprenorphine from both systems were included in each group). Among VA buprenorphine recipients, 199 (26%) received an overlapping opioid prescription and 11 (1%) received an overlapping benzodiazepine prescription from Part D. Among Part D buprenorphine recipients, 208 (19%) received an overlapping opioid prescription and 178 (16%) received an overlapping benzodiazepine prescription from VA. Among VA and Part D buprenorphine recipients with cross-system opioid overlap, 25% (49/199) and 35% (72/208), respectively, had >90 days of overlap.
  
  
  
  Many buprenorphine recipients receive overlapping prescriptions for opioids and benzodiazepines from a different health care system than the one in which their buprenorphine was filled. These findings highlight a previously undocumented safety risk for veterans dually enrolled in VA and Medicare.
authors.affiliation: a Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.|b Division of General Internal Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
authors.forename: Walid F
authors.initials: WF
authors.lastname: Gellad
authors.affiliation: a Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Zhao
authors.affiliation: a Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.|c Department of Pharmacy and Therapeutics , University of Pittsburgh School of Pharmacy , Pittsburgh , Pennsylvania , USA.
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Thorpe
authors.affiliation: a Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.|c Department of Pharmacy and Therapeutics , University of Pittsburgh School of Pharmacy , Pittsburgh , Pennsylvania , USA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Thorpe
authors.affiliation: a Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.
authors.forename: Florentina E
authors.initials: FE
authors.lastname: Sileanu
authors.affiliation: a Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Cashy
authors.affiliation: a Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Mor
authors.affiliation: a Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hale
authors.affiliation: a Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.|b Division of General Internal Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Radomski
authors.affiliation: a Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.|b Division of General Internal Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
authors.forename: Leslie R M
authors.initials: LR
authors.lastname: Hausmann
authors.affiliation: a Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.|b Division of General Internal Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.affiliation: a Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.|b Division of General Internal Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
authors.forename: Chester B
authors.initials: CB
authors.lastname: Good
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000706:statistics & numerical data*; D008875:Middle Aged; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines; D002047:Buprenorphine
keywords: Buprenorphine; opiate substitution treatment; opioid; veterans