# Assessing and Reducing Opioid Misuse Among Veterans in VA and Non-VA Systems: Coordination of Fragmented Care

> **NIH VA I01** · U.S. DEPT/VETS AFFAIRS MEDICAL CENTER · 2024 · —

## Abstract

Project Summary
The US opioid epidemic has put a significant burden on Veterans and the VA. Veterans often suffer from
chronic pain syndromes due to war injuries, toxic exposures, and deployment-related psychiatric comorbidities
and are vulnerable to opioid use/misuse. Chronic pain syndromes occur in 65.4% of U.S. veterans, 9.1% of it
severe, as against 56 and 6.4% in non-veterans respectively. Both opioid misuse and unrelieved pain have
been linked to a higher risk of suicide among Veterans, greater among women. To address the opioid epidemic
in the VA, in August 2013, the VA deployed the Opioid Safety Initiative (OSI) to ensure that opioids are used in
a safe, effective, and judicious manner and the Stratification Tool for Opioid Risk Management (STORM).
Although the implementation of OSI has substantially reduced risky and other opioid prescriptions in VHA and
increased use of non-opioid treatments for pain, there remain major gaps in evidence to formulate
comprehensive policy as current data is almost exclusively derived from Veterans receiving care within the
VHA. This is important as ~80% of the Veterans have private health insurance. It has been reported that
Veterans who receive dual VHA and non-VHA care received more opioid prescriptions and more risky
prescriptions, that mono VHA users. Also, while opioid overdose rates have been increasing in VHA enrollees
VHA Opioid prescriptions in these veterans declined. To address the prescription drug misuse problem, states
use Prescription Drug Monitoring Programs (PDMPs), which are electronic databases that collect and track
prescription data on controlled substances to reduce their abuse and diversion. However, despite access to
these data via Health Information Exchanges (HIE), the guideline-discordant unsafe and concurrent
prescriptions and fillings of opioids continue. Also, PDMP data alone are not suitable for policy decisions and
practice recommendations as they lack the detailed clinical information necessary to make a comprehensive
evaluation of underlying factors associated with non-guideline-concordant prescriptions. Our preliminary data
show a decline in Opioid prescriptions with less decline in the diagnosis of Opioid Use Disorder. The absence
of community data is also mentioned as a major deficiency in the study and analyses of the opioid misuse
crisis in a 2017 VA Office of Inspector General Report. In this VHA HSR&D Merit Review Application we
propose to examine factors associated with prescription opioid misuse, specifically the guideline-discordant
use of opioids, in 3 Veterans groups, (1) VHA mono-users, (2) VHA paid dual users of both VHA and non-VHA
care, and (3) non-VHA paid dual users. We also propose to conduct an interview/focus group study of VA and
non-VA community health providers perspectives on: a) barriers and facilitators in providing guideline-
concordant care to the dual users, and b) coordination strategies to reduce opioid misuse in the dual user
groups. These...

## Key facts

- **NIH application ID:** 11080187
- **Project number:** 5I01HX003100-04
- **Recipient organization:** U.S. DEPT/VETS AFFAIRS MEDICAL CENTER
- **Principal Investigator:** Joel Kupersmith
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-05-01 → 2025-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11080187

## Citation

> US National Institutes of Health, RePORTER application 11080187, Assessing and Reducing Opioid Misuse Among Veterans in VA and Non-VA Systems: Coordination of Fragmented Care (5I01HX003100-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/11080187. Licensed CC0.

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