ARMY NAVY AIR FORCE USPHS
Item of Interest
There exists a major problem in the U.S., including our Military and Veterans, involving opioid use and abuse. The following articles and resources are to stimulate awareness and discussion of potential involvement in making a difference and to 'Never Stop Serving'.
~~~ Veterans and Opioids ~~~
Painkiller Overprescription at 3 Military Hospitals Prompts Scathing Watchdog Report
JANUARY 17, 2020
This article by Richard Sisk originally appeared on Military.com, the premier resource for the military and veteran community.
Patients were routinely overprescribed opioids at three military hospitals under a system that failed to follow medical guidelines, according to a scathing report from the Defense Department's Inspector General.
The IG's audit found that the three hospitals "overprescribed opioids between 2015 and 2017 because policies and processes were not in place to properly monitor and identify" patients receiving more than the federally recommended dose of 90 milligrams of morphine equivalent (MME) daily.
The result was that one patient, or "beneficiary," at Joint Base Elmendorf-Richardson, Alaska, received 2,450 oxycodone tablets over the course of a year, while another was prescribed 4,700 oxycodone tablets over two years, the audit said.
The audit also found that shoddy bookkeeping practices at JBER; Madigan Medical Center at Joint Base Lewis-McChord, Washington; and Naval Medical Center Portsmouth, Virginia, made it impossible to gauge the scope of the overprescribing.
"These errors prevented us from being able to determine the full universe of beneficiaries who were prescribed opioids above the recommended dose of 90 MME," the audit states.
In addition, the "professional courtesy" shown by doctors to each other often served to let glaring instances of overprescribing go unnoticed, it adds.
The report cites an unnamed doctor who "stated that it was a professional courtesy among physicians not to criticize how other physicians provided services and prescriptions to their beneficiaries."
At one of the three hospitals visited by IG teams, a pharmacist stated that "there is not a will" to stop some patients from receiving too many opioids, the audit found.
The report cites Centers for Disease Control and Prevention (CDC) guidelines and the Department of Veterans Affairs' "Clinical Practice Guideline for Opioid Therapy for Chronic Pain" as recommending "against prescribing opioid doses over 90 MME per day to treat chronic pain."
The IG's report does not attribute any deaths or suicides at the three hospitals to overprescribing but cites a Veterans Health Administration study, which concluded that "those who died of opioid overdoses were prescribed an average of 98 MME per day, while others who did not die from opioid overdose were prescribed an average of 48 MME per day."
In the existing system, DoD beneficiaries -- active-duty service members, retirees and eligible family members -- can receive health care at military hospitals and clinics, also known as Military Treatment Facilities (MTFs), on military installations worldwide.
Under the National Defense Authorization Act of 2017, the Defense Health Agency (DHA) and the surgeons general of the service branches are charged with overseeing the MTFs, the audit states.
Pentagon Launches Prescription Monitoring Program
to Curb Substance Abuse
Military hospitals, clinics and pharmacies will soon share information on prescriptions written for controlled substances with civilian doctors in nine states, part of a growing effort to stem addiction and illegal transfer of medications such as opioids within the military population.
Defense Health Agency (DHA) officials said Feb. 5 that the information, which will include the number of prescriptions as well as the quantity and strength of dosages, will be shared to ensure that patients aren't receiving overlapping or additional prescriptions outside the military health system.
The goal is to sign agreements with the 49 states and several territories enrolled in the National Association of Boards of Pharmacy's Prescription Monitoring Program Interconnect System, which monitors prescriptions for restricted drugs nationwide, according to DHA.
Navy Vice Adm. Raquel Bono, director of the DHA, said the launch of the Military Health System Prescription Drug Monitoring Program, or MHSPDMP, gives military and civilian treatment facilities "a powerful tool for opioid safety."
"The [program] will allow civilian and military providers to review patient opioid prescription histories to ensure there are no overlapping opioid prescriptions that can worsen an opioid use disorder or cause an overdose," Bono said in a release.
Each state's monitoring programs differ in the types of medications they track. The DHA did not list the specific medications that would be shared through MHSPDMP, only that it will track "controlled substances."
Read Further HERE
Opioids and Suicide
It is estimated that twenty‑two Veterans die by suicide every day
Pain conditions independently increase risk for suicidal ideation (SI) and suicide attempts and chronic pain is estimated to double the risk of death by suicide
It is estimated that 45% of people who ultimately die from suicide were seen by their primary care provider within one month of their suicide. Patients with chronic pain who are using prescribed opioids have ready access to lethal medication. Opioid prescriptions are the most common medications present in drug overdose deaths. Therefore, weighing the risks and benefits of opioid use for all Veterans is essential.
Read the Factsheet HERE
Safe and Responsible Use of Opioids for Chronic Pain: A Patient Information Guide
The healthcare providers and staff at the Department of Veterans Affairs (VA) are concerned about your pain. We are committed to providing you with the best possible care.
Read Education Guide HERE
VETERANS AND OPIOID ADDICTION
SEP 08, 2017
A three-time Purple Heart recipient, Vietnam veteran Donald Elverd spent two years in Army hospitals, recovering from shrapnel wounds that ravaged his body. One bullet had pierced a lung; another, his arm. Bone splinters filled his chest.
When Sergeant Elverd of the 25th Infantry Division was discharged in 1970, he walked out of the Army “with a lifetime prescription from the VA.” From there, he dove headfirst into a downward spiral of drug addiction.
VA Report: Vets In Private Care Are At Higher Risk For Opioid Addiction
on August 1, 2017
As the Senate today deliberated on an emergency funding bill for the Department of Veterans Affairs’ premier private-health program, a new government report is warning of “a significant risk” of addiction and health complications for veterans who are prescribed opioid prescriptions outside the VA.
The July 31 VA inspector general report found that the department is having communications problems with the private-sector healthcare providers they hire to treat veterans — problems that could lead to overprescription of addictive opioid drugs for pain management, a nationwide trend that’s fueled the U.S.’s recent prescription-addiction and overdose epidemic.
Opioid Safety Initiative (OSI)
Management of Opioid Therapy (OT) for Chronic Pain (2017) - VA/DoD Clinical Practice Guidelines
There is a mounting body of research detailing the lack of benefit and potentially severe harm of long-term opioid therapy. Since the publication of the Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain in 2010, there has been a growing epidemic of opioid misuse and opioid use disorder in America. The 2017 updated guideline is based on a systematic review of both the clinical and epidemiological evidence available as of December, 2016.
The guideline was developed by a panel of multidisciplinary experts and it provides a clear explanation of the logical relationships between various care options and health outcomes while rating both the quality of the evidence and the strength of the recommendation. This guideline is intended to provide healthcare providers with a framework by which to evaluate, treat, and manage the individual needs and preferences of patients with chronic pain, who are currently on or are being considered for long-term opioid therapy (LOT).
Link to the VA/DoD Clinical Practice Guidelines