
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.
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