Appropriate clinical response following opioid overdose: A retrospective analysis within the Veterans Health Administration system

Abstract: BACKGROUND: Opioid overdose (OD) remains a pressing public health crisis in the United States, with substantial gaps in postoverdose care, particularly among veterans. Understanding the demographic and clinical factors associated with appropriate postoverdose care is essential to addressing these gaps. METHODS: A retrospective cohort study of 1032 veterans who experienced a nonfatal opioid overdose and received care through the veterans Health Administration system was conducted. Data were extracted from electronic health records, including demographic, pharmacy, and clinical variables. The primary outcome was receipt of appropriate clinical response within 90 days postoverdose, defined as initiation of medication for opioid use disorder (MOUD), counseling for opioid use disorder (OUD), or a ≥25% reduction in morphine equivalent daily dose. A binary logistic regression model was used to examine factors associated with receiving appropriate overdose care. RESULTS: Of the total sample, 57.46% received an appropriate clinical response postoverdose, the majority of which reflected opioid dose reductions rather than initiation of MOUD or counseling for OUD. There were statistically significant differences between those who received appropriate clinical response versus not by rurality, marital status, substance use disorder and treatment, care access, bipolar disorder, and schizophrenia. In adjusted models, those with a documented substance use disorder had significantly higher adjusted odds of receiving appropriate clinical response (aOR=1.91; 95% CI: 1.38-2.63; P<0.0001). Black veterans had significantly lower odds of receiving appropriate clinical response compared with White veterans (aOR=0.71; 95% CI: 0.51-0.98; P=0.04). Other variables were not statistically significantly associated with appropriate clinical response in the adjusted model. CONCLUSIONS: The primary response to OD was dose reduction and MOUD was profoundly underutilized. Future research should incorporate social determinants of health to better understand contextual influences on overdose risk and care access.