Conflicting guidelines for prescribing opioids increasing risks for veterans

OIG: Immediate need for improved coordination between VA, non-VA providers

By Jodi Mohrmann - Managing Editor of special projects

JACKSONVILLE, Fla. - The nation's opioid crisis is having a significant impact on the veteran population, and after the Office of Inspector General for the Department of Veterans Affairs looked at how these painkillers are currently being prescribed, it finds veterans are being put at an increased risk.

According to an OIG report released today, there is an immediate need for change because of conflicting guidelines for VA and non-VA providers. 

The inspection 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.

The report cited fragmented care coordination between VA and non-VA providers -- as well as differing clinical standards for managing pain -- placing certain veterans at increased risk for overdose or complications associated with prolonged opioid use.

“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.”

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. However, community providers are not obligated to follow to these guidelines. OIG said 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. 

According to OIG, VA agreed with the recommendations and submitted action plans to implement them. 

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