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Opioid Prescribing and Opioid Risk Mitigation Strategies in the Veterans Health Administration
Friedhelm Sandbrink1,2,3,4, Elizabeth M Oliva5,6, Tara L McMullen7
1Pain Management and Opioid Safety Program, Veterans Health Administration, Washington, DC, USA. Friedhelm.Sandbrink@va.gov.
Journal of General Internal Medicine
|November 16, 2020
Summary
The Veterans Health Administration (VHA) significantly reduced opioid prescribing and co-prescribing with benzodiazepines. This opioid stewardship initiative improved safety and pain management for Veterans.
Area of Science:
- Health Services Research
- Public Health
- Pharmacology
Background:
- The Veterans Health Administration (VHA) is the largest integrated healthcare system in the U.S.
- Addressing opioid safety and stewardship is a national priority.
- VHA has implemented multifaceted strategies to manage opioid prescribing.
Purpose of the Study:
- To evaluate current opioid prescribing practices within the VHA.
- To assess the implementation of opioid risk mitigation strategies.
- To analyze the impact of VHA's opioid stewardship program.
Main Methods:
- Analysis of VHA prescribing data through Q1FY2020.
- Review of opioid risk mitigation strategies and their implementation.
- Data collection from Pharmacy Benefits Management Services, Pain Management Program Office, PEPReC, and facility surveys.
Main Results:
- Opioid dispensing decreased by 56% since 2012; opioid/benzodiazepine co-prescribing decreased by 83%.
- High-dose opioid use (≥100 mg MEDD) reduced by 77%.
- High rates of informed consent, urine drug screens, and PDMP queries for long-term opioid therapy patients; naloxone issued to 217,469 Veterans.
Conclusions:
- VHA clinicians have substantially decreased opioid prescribing for pain management.
- Implementation of opioid risk mitigation strategies has been expanded.
- VHA's integrated system serves as a model for opioid stewardship and interdisciplinary pain care.
