Recently, the Department of Veterans Affairs (VA) Office of Inspector General (OIG) released its Healthcare Inspection report, Opioid Prescribing to High-Risk Veterans Receiving VA Purchased Care, in an attempt to identify the need for improved care coordination between VA and non-VA healthcare providers prescribing opioids to veterans.
The report reviewed opioid prescribing to high-risk veterans, such as those with chronic pain and co-occurring mental health illnesses, receiving VA-purchased care from the Veterans Choice and other non-VA community provider programs. According to the report, fragmented care coordination between VA and non-VA providers, as well as differing clinical standards for managing pain, places veterans at an increased risk for overdose or complications associated with prolonged opioid use.
In creating the report, the VA OIG conducted interviews with VA leadership and staff, reviewed the VA/DoD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, as well as VA’s Opioid Safety Initiative, current medical literature, and the VA-purchased care Choice contract.
Report Findings and Recommendations
The report notes that while the ability to query PDMP databases is now available, VA providers would not likely access the PDMP when they are not prescribing controlled substances to a specific patient. Timely notification of veteran patients receiving non-VA opioid prescriptions would allow more immediate VA provider awareness and action, if any action were required. For example, if all routine non-VA opioid prescriptions were submitted directly to VA pharmacies, VA pharmacy staff could alert the VA provider of record that a non-VA opioid prescription was being dispensed. This would also allow the same level of pain management committee oversight by VA of opioid prescriptions prescribed by VA and non-VA providers.
While the VA’s Opioid Safety Initiative provides VA healthcare providers a framework to evaluate, treat, and manage patients with chronic pain or long-term opioid therapy, community providers are not obligated to adhere to these guidelines. This can present significant patient safety and care management challenges when community care providers’ prescribing and monitoring practices conflict with the VA’s evidence-based guidelines.
The OIG report recommends that non-VA providers be required to submit prescriptions for opioids directly to VA pharmacies so that these prescriptions can be tracked and coordinated with medications prescribed by VA care providers; to review evidence-based guidelines for prescribing opioids; and to include in care consults an updated list of the patient’s medications. The VA concurred with the recommendations and submitted action plans to implement them.
Conclusion
“Veterans receiving opioid prescriptions from VA-referred clinical settings may be at greater risk for overdose and other harm because medication information is not being consistently shared,” said Michael J. Missal, Inspector General, U.S. Department of Veterans Affairs. “That has to change. Healthcare providers serving veterans should be following consistent guidelines for prescribing opioids and sharing information that ensures quality care for high-risk veterans.”