Decreasing Pain Medication Risks for Disabled Veterans

Pain management is a big issue nationwide, and the overuse and abuse of narcotic (opioid) pain medications is a major public health issue. Disabled veterans have a higher risk of pain medication use and abuse than the general population due to the nature of their disabilities.

In 2012, in response to reports that the VA was not doing a very good job managing opioid use in veterans with severe or chronic pain, the VA conducted a study to evaluate its use and management of opioid medications. The study showed that in 2012 the VA dispensed nearly 1.7 million prescriptions for opioid medications to 453,616 patients. The study also showed that the VA was not doing a very good job of monitoring those patients as mandated in the Clinical Practice Guidelines issued in 2009.

To correct these problems, the VA began the Opioid Safety Initiative (OSI) in 2012. The OSI was designed to better provide effective, safe pain management for veterans. As a result of the OSI program, the VA reports that there are now:

            “- 91,614 fewer patients receiving opioids;

 - 29,281 fewer patients receiving opioids and benzodiazepines together;

 - 71,255 more patients on opioids that have had a drug urine screen to help

      guide treatment decisions;

 - 67,466 fewer patients on long-term opioid therapy”

In addition, the VA, along with the National Institutes of Health, is now actively conducting research into alternatives to opioid therapy for pain management, such as alpha-stimulation devices, acupuncture and other cutting edge options.

Last month, the VA announced that the Opioid Therapy Risk Report (OTRR) is now available for use by all VA staff. The OTRR is a state-of-the-art tool designed to help providers treat and protect veterans taking high doses of opioid medications or those with an increased risk of complications from opioid use.

The OTRR includes information about sedatives and other narcotics, including dosages and risks of adverse reactions, such as addiction, overdose and/or death. It also includes monitoring data to help providers manage pain in their patients. Providers now have access to all of the current clinical data related to pain management in one place, giving them a more comprehensive and efficient veteran-centered program of pain care.

While we are excited about the progress the VA is making to help our veterans manage their pain and avoid things like addictions, we must acknowledge the problems that have arisen as a result of new DEA regulations regarding the prescription of opioid medications. Under the new regulations, providers can only write a prescription for a 30-day supply of medication at a time, which means that veterans on long-term opioid medication must return to their provider once a month for their prescription. Although the VA has made progress in cutting wait times for appointments, increasing the number of appointments veterans need to properly remain supplied with their medications means that many veterans will still have difficulty getting timely appointments. If you struggle with this issue, the Choice Cards may be able to help. In addition, the VA recognizes this problem and is having staff members meet with veterans personally to help ensure the continuity of their pain management.