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Senate committee rakes VA over the coals for excessive prescribing of opioid painkillers
A troubled Marine who overdosed and died in a VA psych ward is only one of many cases of overdose in recent years. But the VA assured the Senate committee in March that the rampant opioid prescribing has begun to ease off and other measures are being taken.
The Veteran’s Affairs has come under the gun after a damning report by the Center for Investigative Reporting on opioid prescribing at a VA hospital in Wisconsin found a 14-fold increase in oxycodone pills prescribed.
The Center found opioid painkillers prescribed at the Tomah VA Medical Center soared from 50,000 hydrocodone pills in 2004 to 712,000 pills in 2012. There was apparently no significant increase in the number of patients – just in the number of oxycodone pills prescribed per patient.
Veterans also told a reporter that opioid use was so rampant at the hospital that the soldiers gave the place the nickname “Candy Land.”
When a 35-year-old Marine Corps veteran died of an opioid overdose while in the hospital’s psych ward last August, it was only the latest in a long string of heartbreaks for veteran’s families going back many years.
Numerous reports from the VA Inspector General (IG) over the past five years say veterans are dying from medication overdoses across the country. Whistleblowers have also alerted the IG several times about dangerous opioid and benzodiazapine prescribing practices – a particularly deadly cocktail.
Tests not being done, leaving patients at risk
Yet in spite of the deaths, whistleblower warnings and the IG’s official reports, routine drug tests to monitor narcotics uses and abuses are still not being performed in the nation’s VA hospitals or among the many thousands of outpatients receiving medications.
And according to the reports, doctors are even prescribing medications to patients they have not even seen in person. Although this is a violation of written VA policy, one would think it’s a violation of basic ethical medical practice anywhere.
And just a couple of weeks ago, a former pharmacist at the Tomah VA told the committee she was “discouraged by higher-ups” from performing drug tests, in contravention of VA guidelines.
Noelle Johnson, who was fired from that facility and now is employed as a VA pain management specialist in Des Moines, said pharmacists at Tomah were discouraged from testing patients for drug use for fear of what “prescribing physicians might learn.”
Johnson said she was told that if the tests were negative, it could indicate the patient wasn’t taking their meds and were instead maybe selling them. And if the tests were strongly positive, it could “suggest overuse or abuse” and the VA could be held liable “when something unfortunate happened.”
“I believe that this is the point of urine drug testing, to substantiate use and misuse of high-risk medications for the safety of veterans and the public,” Johnson told the committee. “What happened to the doctors’ oath of ‘First Do No Harm?’”
VA is taking steps, says spokesperson
Dr. Carolyn Clancy, the VA’s interim Under Secretary for Health, told the committee that the VA has gotten the message and is taking steps to remedy the situation. Clancy said that the best way to curtail prescription drug abuse and overdose is to avoid prescribing addictive medications like fentanyl, hydrocodone or oxycodone. She said that several VA programs are in place and already working to reduce the number of prescriptions and subsequent “accidental deaths.”
“Chronic pain management is challenging for veterans and clinicians,” Clancy told the Committee. “Opioids are an effective treatment but their use requires constant vigilance to minimize risk and adverse effects.”
Clancy said a program to educate physicians on the VA’s narcotics prescription guidelines was introduced in three areas in 2013 and has been adopted by about a third of the VA’s health regions. It’s already bringing about reductions in the number of prescriptions, and also beefing up appropriate testing and tracking of patients, she said, and the VA will expand the program to include all its medical centers.
Another program, Clancy said, is called the Opioid Safety Initiative, also started in 2013, and is also helping reduce the numbers of opiate prescriptions. Since 2012, the number of patients receiving opioids has declined by 13 percent, she said, and those using opioids and benzodiazepines together — a cocktail that can have fatal consequences if taken incorrectly — has dropped by 24 percent.
Clancy also told the Veteran’s Affairs Committee about VA’s Overdose Education and Naloxone Distribution program (OEND) which provides emergency kits containing the opioid overdose antidote drug naloxone to veterans on high doses of opiates or who use multiple medications to manage pain.
Naloxone program saving lives
Since its introduction last May, she said, more than 2,400 kits have been provided to such veterans, their families or friends. And at least 41 veterans have been rescued from overdoses since the OEND program began.
Naloxone instantly reverses the respiratory depression that kills the victims of opioid overdose. It’s administered by nasal spray or injection, and is easy enough for anyone with a few minutes of instruction to use. It’s normally carried in ambulances, is used at all ERs, and is carried by many police forces across the country, since cops are very often on the scene of overdoses even before the EMT people.
The overuse of opiates for pain management and the resulting widespread dependencies, abuses and addictions to these highly addictive medications is not just a VA problem. Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, recently called the overprescribing of opioids “a national epidemic.”
Frieden said the prescribing practices of America’s physicians is the primary source of the epidemic. But the VA’s physicians went to all the same med schools as the rest of America’s doctors. So we shouldn’t expect anything different at the VA.
The Institute of Medicine says a hundred million Americans are suffering from chronic pain on any given day. Yet medical schools devote less than two days – maybe 8 to 10 hours tops – to the treatment and management of pain, including chronic pain. There are only a few thousand actual certified pain specialists in the entire country – just a drop in the bucket.
Senator says he’s “angered and disgusted”
Ranking committee member Sen. Richard Blumenthal (D-CT) said he is “angered and disgusted” that so little appears to have been accomplished to address overprescribing since the committee’s last session on the same topic.
“I want this hearing to be different, to produce action,” Blumenthal said. “This epidemic has been with us for years and years and that’s one reason for my anger and astonishment that the VA system isn’t better than it is.”
Here at Novus, we’re also looking forward to a time when opioid prescribing in and out of the military is under control. Meanwhile we’re here 24/7 helping people who have fallen victim to prescription opioids. If you or someone you care about is suffering from the addictive effects of prescription pain meds, don’t hesitate to give us a call. We’re always here to help.
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