{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T02:40:23Z","timestamp":1776652823463,"version":"3.51.2"},"reference-count":34,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T00:00:00Z","timestamp":1689724800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006380","name":"Rehabilitation Research and Development Service","doi-asserted-by":"publisher","award":["RCS 04\u2010141\u20103"],"award-info":[{"award-number":["RCS 04\u2010141\u20103"]}],"id":[{"id":"10.13039\/100006380","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["2UG1DA015815\u201019"],"award-info":[{"award-number":["2UG1DA015815\u201019"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["2R37DA01561216"],"award-info":[{"award-number":["2R37DA01561216"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>To compare healthcare costs and use between United States (US) Veterans Health Administration (VHA) patients with opioid use disorder (OUD) who experienced an opioid overdose (OD cohort) and patients with OUD who did not experience an opioid overdose (non\u2010OD cohort).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>This is a retrospective cohort study of administrative and clinical data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The largest integrated national health\u2010care system is the US Veterans Health Administration's healthcare systems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>We included VHA patients diagnosed with OUD from October 1, 2017 through September 30, 2018. We identified the index date of overdose for patients who had an overdose. Our control group, which included patients with OUD who did not have an overdose, was randomly assigned an index date. A total of 66 513 patients with OUD were included for analysis (OD cohort: <jats:italic>n<\/jats:italic> = 1413; non\u2010OD cohort: <jats:italic>n<\/jats:italic> = 65 100).<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Monthly adjusted healthcare\u2010related costs and use in the year before and after the index date. We used generalized estimating equation models to compare patients with an opioid overdose and controls in a difference\u2010in\u2010differences framework.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Compared with the non\u2010OD cohort, an opioid overdose was associated with an increase of $16\u2009890 [95% confidence interval (CI)\u2009=\u2009$15\u2009611\u201318\u2009169; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001] in healthcare costs for an estimated $23.9 million in direct costs to VHA (95% CI\u2009=\u2009$22.1 million, $25.7 million) within the 30\u2009days following overdose after adjusting for baseline characteristics. Inpatient costs ($13\u2009515; 95% CI\u2009=\u2009$12\u2009378\u201314\u2009652; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) reflected most of this increase. Inpatient days (+6.15\u2009days; 95% CI,\u2009=\u20095.33\u20136.97; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), inpatient admissions (+1.01 admissions; 95% CI\u2009=\u20090.93\u20131.10; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and outpatient visits (+1.59 visits; 95% CI\u2009=\u20091.34\u20131.84; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) also increased in the month after opioid overdose. Within the overdose cohort, healthcare costs and use remained higher in the year after overdose compared with pre\u2010overdose trends.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The US Veterans Health Administration patients with opioid use disorder (OUD) who have experienced an opioid overdose have increased healthcare costs and use that remain significantly higher in the month and continuing through the year after overdose than OUD patients who have not experienced an overdose.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.16289","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T10:16:24Z","timestamp":1689761784000},"page":"2203-2214","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Healthcare costs and use before and after opioid overdose in Veterans Health Administration patients with opioid use disorder"],"prefix":"10.1111","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2484-4625","authenticated-orcid":false,"given":"Vilija R.","family":"Joyce","sequence":"first","affiliation":[{"name":"VA Health Economics Resource Center, US Department of Veterans Affairs VA Palo Alto Health Care System  Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8318-3049","authenticated-orcid":false,"given":"Elizabeth M.","family":"Oliva","sequence":"additional","affiliation":[{"name":"VA Center for Innovation to Implementation, US Department of Veterans Affairs VA Palo Alto Health Care System  Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla C.","family":"Garcia","sequence":"additional","affiliation":[{"name":"VA Health Economics Resource Center, US Department of Veterans Affairs VA Palo Alto Health Care System  Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jodie","family":"Trafton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Stanford University  Stanford CA USA"},{"name":"VA Program Evaluation and Resource Center Office of Mental Health and Suicide Prevention, VA Central Office, US Department of Veterans Affairs  Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven M.","family":"Asch","sequence":"additional","affiliation":[{"name":"VA Center for Innovation to Implementation, US Department of Veterans Affairs VA Palo Alto Health Care System  Palo Alto CA USA"},{"name":"Department of Medicine Stanford University  Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd H.","family":"Wagner","sequence":"additional","affiliation":[{"name":"VA Health Economics Resource Center, US Department of Veterans Affairs VA Palo Alto Health Care System  Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0694-5761","authenticated-orcid":false,"given":"Keith","family":"Humphreys","sequence":"additional","affiliation":[{"name":"VA Center for Innovation to Implementation, US Department of Veterans Affairs VA Palo Alto Health Care System  Palo Alto CA USA"},{"name":"Department of Psychiatry and Behavioral Sciences Stanford University  Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas K.","family":"Owens","sequence":"additional","affiliation":[{"name":"Stanford Health Policy, Department of Health Policy Stanford University  Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Bounthavong","sequence":"additional","affiliation":[{"name":"VA Health Economics Resource Center, US Department of Veterans Affairs VA Palo Alto Health Care System  Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"US Department of Health and Human Services.HHS acting secretary declares public health emergency to address national opioid crisis.HHS.gov. 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