BACKGROUND: National trends indicate that drug-related deaths among Veterans have been increasing from 2010 to 2019. The present study involves a recent analysis of drug mortality data for a single large Veterans Affairs (VA) Healthcare System. The aims of the study included (1) the identification of VA patients with drug-related deaths, (2) patient characteristics and service utilization patterns of VA patients with drug-related deaths, and (3) the evaluation of existing internal tracking systems for monitoring drug-related deaths.
METHODS: This retrospective study matched VA enrollment records to San Diego County Medical Examiner (ME) data from January 2019 to June 2023. The records of individuals who died of a drug-related overdose in San Diego County were matched to VA medical records. Chart reviews were conducted to evaluate the extent to which intentional and accidental overdose events were documented in electronic medical records, and to examine demographic and clinical characteristics and healthcare utilization in Veterans who died by overdose.
RESULTS: From January 2019 to June 2023 there were a total of 140 drug overdose deaths, 91.4 % were accidental (n = 128) and 8.6 % were intentional (n = 12). Prior to ME data matching, VA records captured 9.6 % of accidental drug overdoses (n = 15) and 100 % of intentional drug overdoses (n = 12). Fentanyl or fentanyl analogs were involved in 37.1 % (n = 52) of intentional and unintentional drug overdose deaths with the combination of fentanyl and methamphetamine being the next most specific common cause of death (n = 30; 21.4 %). In terms of VA healthcare utilization, in the year prior to their death, 63.6 % of Veterans accessed care. Among those 89 VA patients, they most commonly utilized the emergency department (75 %) and primary care (56.2 %). Among the 20 % of Veterans with opioid use disorder (OUD), in the year prior to their death, 39.3 % were dispensed a prescription for naloxone and 35.7 % were dispensed a medication for OUD.
DISCUSSION: Comparing VA records to county ME records revealed that VA records missed over 80 % of drug-related overdose deaths—4 out of every 5 deaths. While accurate for intentional overdoses, accidental overdoses—which comprise the vast majority of drug overdose deaths—were missing over 90 % of the time. Given that drug toxicology results were consistent with county trends, this suggests that VA records severely underestimate drug overdose deaths. Approximately two-thirds of VA patients who died of drug overdose access VA and most were seen in the emergency department and over half in primary care—identifying these as important intervention targets for overdose prevention. Given the gaps in capturing drug overdose deaths, other healthcare systems looking to prevent overdose deaths, and especially other VA systems, may want to consider adopting similar methods to better capture and understand factors that impact drug overdose deaths among their patient populations.
New methodology to improve tracking of Veteran overdose deaths and characterization of a population of Veteran overdose decedents in San Diego County
Drug and Alcohol Dependence Reports, 17, 100392. doi: 10.1016/j.dadr.2025.100392.