28 Jul VA Shows Slight Drop in Opioid Pain Prescriptions
Given the nature of the work that many veterans performed during their service in the U.S. military, it is not surprising that a large number of them require treatment for chronic pain. Back pain and joint pain are the two most frequent complaints among armed forces veterans, while a smaller number experience long-term pain resulting from serious injuries sustained in combat.
Chronic pan is generally defined as consistent pain in one or more areas of the body lasting between three and six months. Chronic pain can also last much longer, and many veterans suffer from chronic pain over the course of years. One study published in the Journal of Rehabilitation Research and Development in 2009 found that 81.5 percent of veterans of Operation Iraqi Freedom and Operation Enduring Freedom reported experiencing chronic pain.
Unfortunately, information from the Department of Veterans Affairs (VA) indicates that treatment options for veterans in pain are somewhat limited. Despite the large percentage of veterans who live with chronic pain, the VA only employs 115 physicians nationwide who specialize in the treatment of pain. That equates to approximately one pain specialist for every 50,000 veterans with chronic pain problems. Options for alternative care can also be limited in some places; for example, the VA only employed 39 chiropractors in 2012.
Opiate Prescriptions and Opiate Addictions Grow
With limited access to specialists and alternative treatments, VA physicians have been relying heavily on prescription opioids like oxycodone, hydrocodone, methadone and morphine in order to treat pain. A 2013 report from the Center for Investigative Reporting (CIR) showed that prescriptions for these four painkillers increased by 270 percent between 2001 and 2012.
At the same time, studies have found that the number of veterans diagnosed with opioid addiction has risen steadily over the last decade. In addition, the number of fatal overdoses from prescription opiates among veterans has risen to nearly twice the rate of fatal opiate overdoses in the general population.
Opioid Safety Initiative
The report on opioid prescriptions from the CIR prompted a congressional hearing in October 2013. In response to media scrutiny and congressional pressure, the VA founded the Opioid Safety Initiative (OSI) immediately following the hearing.
The OSI involves a variety of strategies for reducing opioid use among veterans. These strategies involve increasing the availability of alternative treatment options like chiropractic, acupuncture and spinal cord stimulation, and increasing the use of non-opioid medications that have less potential for abuse. The initiative also involves increasing patient education and monitoring efforts to help prevent abuse and addiction among veterans who continue to receive opioid drugs. Finally, the VA hopes to increase veterans’ access to specialists who can improve treatment of the root causes of chronic pain, rather than simply treating the pain.
The OSI is employing both personnel and technology in its efforts to reverse the startling increase in opioid prescriptions uncovered by the CIR. They plan to equip each VA hospital with a Pain Medicine Specialty Team and Consult Services, as well as Facility Pain Committees. Technological resources include the pain management app, Pain Coach, and an online library of pain management resources at My HealtheVet.
In the five months since the VA began to initiate the OSI around the country, they are reporting modest reductions in the number of veterans being treated with opioids. Since October 2013, the VA says that nearly 20,000 fewer veterans are now treating their pain with opioids, a drop from 665,786 to 646,234. These figures would constitute an overall reduction in opioid use among veterans of about 3 percent.
The VA also reports more significant rates of success in certain locations. The OSI was first implemented in Minneapolis, Minn., and the VA says that eight Minneapolis VA sites have succeeded in reducing the number of patients receiving opioid treatment for pain by more than 50 percent.
Nevertheless, it will still take some time before alternative pain treatment options are widely and rapidly available around the country. As they wait for OSI measures to take effect, many veterans continue to report delays of weeks or months before specialist care is available, and continue to rely on opioids in the meantime.
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