Purpose Veterans using Veterans Affairs (VA) healthcare have twice the risk of fatal prescription drug overdose (PDO) than non-Veterans. This elevated risk may be related to Veteran receipt of opioid prescriptions from both inside and outside the VA system. State prescription drug monitoring programs (PDMPs) can help reduce PDO by providing data on patients prescriptions across healthcare systems; however, to date, little research has leveraged PDMP data to understand Veterans PDO risk.

Methods We conducted two analyses using VA and PDMP data. First, VA data for 23,052 VA users in a single state were probabilistically linked to PDMP data to examine incidence and patterns of dual VA/non-VA use of opioid prescribers. Second, using VA data from a four-state region, we examined prevalence and correlates of VA prescribers documentation of PDMP queries for 25,809 Veterans receiving long-term opioid therapy from 2015–2016.

Results Results of the first analysis showed that, from 2011–2016, 53% of Veterans with VA opioid prescriptions also received non-VA opioid prescriptions in the same year; age, race, marital status, and health diagnoses such as depression and substance use disorder (SUD) were associated with dual use. Results of the second analysis showed that, among Veterans on opioid therapy, 64% had a documented PDMP query. Veterans were more likely to have a PDMP query if prescribed higher morphine-equivalent doses or if diagnosed with a substance use disorder.

Conclusion While the prevalence of dual VA/non-VA use of opioid prescribers in a single state was high, more than 1/3 of Veterans receiving opioids in the VA did not have a documented PDMP query.

Significance PDO is a leading cause of fatal injury and is especially important among Veterans who use VA healthcare. Increased use of PDMP data for research and healthcare may help ameliorate PDO in this population.