Legislators Call on VA to Stop Over-Prescription of Powerful Painkillers

By Sandra Basu

WASHINGTON — In the wake of accusations that veterans are over-prescribed powerful painkillers, a House of Representatives subcommittee chairman called on VA to adopt more effective pain management protocols.

 “The stakes are too high for VA to continue to get it wrong,” said Rep. Dan Benishek, MD, (R-MI), who chaired a subcommittee hearing titled Between Peril and Promise: Facing the Dangers of VA’s Skyrocketing Use of Prescription Painkillers to Treat Veterans.”

Benishek questioned VA for using what he says is a pain management treatment model “that makes primary care, rather than specialty care, the predominant treatment setting for veterans suffering from pain.” Benishek worked part-time at the Oscar G. Johnson VA Medical Center in Iron Mountain, MI, for 20 years.

The hearing came on the heels of a report by the Center for Investigative Reporting that VA prescriptions of hydrocodone, oxycodone, methadone and morphine increased by 270% in the past 12 years. The data for the report was obtained through the Freedom of Information Act.

“VA can and must change course and act now to reduce their reliance on the use of prescription painkillers,” Rep. Jeff Miller (R-FL), chairman of the House Committee on Veterans’ Affairs, said at the hearing.

Rep. Dan Benishek, MD, (R-MI), worked part time as a physician at the Oscar G. Johnson VA Medical Center in Iron Mountain, MI, for 20 years.

Toll of Painkillers

Veterans and family members of deceased veterans testified at the subcommittee about the toll of overprescribing opioids at VA facilities.

Heather Renae McDonald told lawmakers that her husband, Scott Alan McDonald, was treated by the VA and was on up to 15 pills a day within the first six months of back pain and mental health treatment. In September of 2012, she said she found her husband dead on their couch after he had been prescribed Percocet.

McDonald maintained that her husbands’ liver was inflamed and that VA clinicians would have known that if they had done liver function testing, in light of the large number of medications he was taking.

“When I asked VA why more tests were not performed to make sure he was healthy enough, they responded that it was not routine to evaluate our soldiers’ pain medication distribution,” she told lawmakers.

Kimberly Stowe Green, meanwhile, told lawmakers that her husband, Ricky Green, died in 2011 “because of the prescription pain and sleeping medications that VA and its doctors prescribed for him.” Green said that the Arkansas State Crime Laboratory and the state medical examiner performed an autopsy and found the cause of death was “mixed drug intoxication.”

“The VA already has written guidelines for prescribing painkillers, but these are not being followed,” she told lawmakers.

Justin Minyard, who is medically retired from the Army, said that he had suffered from back pain and was prescribed painkillers by both DoD and VA healthcare providers. At his worst point, he said he was taking enough opioid pain medication to treat four terminally ill cancer patients.

After looking for other options to control his pain, he found a doctor at Fort Bragg who was conducting a clinical trial of spinal cord stimulation. That treatment has been successful for him, and he said he is now off opioids. He cautioned, however, that not all veterans and servicemembers have the resources and awareness to advocate for alternatives to opioids pain regimens.

“My wife had to advocate for me, not taking ‘no’ for an answer,” he said in his written statement.

Physician Pressure

In other testimony, two VA physicians testifying before the House subcommittee said they were pressured to prescribe painkillers to patients.

Pamela Gray, MD, told the subcommittee she was coerced into prescribing prescription painkillers at the Hampton, VA, VAMC, where she worked from 2008 to 2010 before being fired after she objected to those practices, according to her testimony.

“During my two-year period, I was coerced to writing drug [prescriptions] that I knew in my medical experience were wrong. When I would object, I was simply told to do it or else,” she said.

Gray further said that she would document in her medical notes in the electronic health record that she was being coerced by nonmedical employees to write prescriptions for opioids but that the notes were altered.

Gray also said she was named the head of pain management at her medical center on the first day of her job, despite havingno training for it.

“I was never asked if I wanted to assume this role. I was informed. I was [in] pain management with zero training,” she explained. “My concern with that is that it is not standard of care.”

Another clinician, Claudia J. Bahorik, DO, also told lawmakers of the predicament facing VA physicians when it comes to prescribing painkillers.

“It is not uncommon for a doctor to refuse to write a narcotics prescription only to have the [veteran] go to the administration,” she said. “What happens? The administrator calls another doc and tells them to write the prescription or the vet will go to the emergency room to get their narcotics. Worse yet, doctors are being verbally abused, attacked or injured when veterans who are on dangerous concoctions of mind-altering substances are cut off.”

In response, VHA Principal Deputy Undersecretary of Health Robert L. Jesse, MD, thanked the family members of the deceased veterans for sharing their stories at the hearing. He also told the subcommittee that VA is “strongly committed to ensuring veterans do have what they need to manage their pain, and that includes not just medications.”

“This is not an issue limited to veterans. Veterans are a population who are particularly challenged, but this is a national crisis,” Jesse pointed out.

When lawmakers asked Jesse about concerns that physicians were pressured to write prescriptions, he said that was “absolutely indefensible” and that, as physicians, they should “feel absolutely that they should refuse to do that.”

Also testifying was Steven Scott, MD, VHA chief of physical medicine and rehabilitation service. He discussed the pain-reduction strategies used at the James A. Haley Veterans’ Hospital and Clinics in Tampa, FL. The facility has both an inpatient and outpatient Chronic Pain Rehabilitation Program that uses a variety of strategies.It has been twice recognized as a Clinical Center of Excellence by the American Pain Society, according to Scott’s written testimony.

Still, lawmakers suggested that the system must be fixed. Rep. Julia Brownley (D-CA) said that while she has faith that there are pockets of excellence in the VA, the system “appears to be broken.”

“How do you respond to the comments that we have a system of quick-and-cheap over good-and-thorough and that the basic principles of medicine have been abandoned?,” she asked.

“I don’t believe that is the case systemwide,” Jesse responded.

Comments (19)

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  1. Rattoo says:

    These propagandists must think the American people are stupid. Due to the nature of their serious injuries and the way wounds, nerve injuries, and breaks healed, many Vets are in severe life-long pain. The number of people overdosing or abusing painkillers is tiny. These Vets need painkillers to make life bearable. This propaganda War is just another way to save money on the backs of Vets, and drive Vets in pain to suicide. Is this what the government wants?

    • Chris says:

      Right on the money, I have chronic back leg and knee pain and vicodin only helps mask it, I only take it when in dire pain, but I’ll take this over anything else. Pain management, yoga medics, steroid injections, cortisone injection, nothing works, and some made it worse. I’m still tweaking my meds to find a perfect combo, but I have a very specific system designed and it works really well. Not everyone will benefit from pain killers but it’s possible to find a working combo.

    • veteran nurse says:

      I agree, we have a group of doctors at the Tampa outpatient that want me to tells patients to loose weight, do yoga, see a psychologist or spend 3 weeks out of work get into in-patient care at the cost of their jobs and lively hood because they (who have never had such pain) don’t believe in opioids. We have even have a man jump off the balcony when he was denied and not even seen by his doctor when he brought test results to present as proof as to why he needed more pain meds. now he, who is in a hospital for his injuries is seen as the dangerous bad guy.

    • Joe Gerringer says:

      Exactly! I don’t even take anything that’s a Narcotic but even my pain meds I take the VA simply keeps sending them without giving me any other care. And now whenever I call for a renewal (since they only give one script at a time) they are starting to make that difficult as well. They countless of times tell me I need to see my doctor before calling the Pharmacy for a renewal but my doctor is old, slow, and frankly I don’t think even cares for me to show up just to ask for another prescription! Ridiculous service and ridiculous operating procedures. Thank goodness my wife is a nurse and soon I can find other treatment for my neck pain. But you would think the VA would do all they could since it’s not like I hurt it over time. An IED broke my neck!

  2. Ron Sacks says:

    It seems to me that if the VA were doing their job, overdoses and combination drug interactions causing the deaths of Veterans, would be much less and opioid prescriptions would not be an issue. I am a 100% T & P disabled vet with severe back and leg pain. I’ve been taking Hydrocodone for about 13 years, it works for me! Now, with all this talk of suicides and miss-use, the VA stopped prescribing the hydrocodone altogether. After several attempts by the VA to get my body to accept Oxycodone, oxycotton, methodone gabbapenton without causing adverse effects, they wrote me a prescription for extended release Hydrocodone to be filled outside the VA at my expense. I’ve never taken more than prescribed, don’t sell, hand out, or take the medication for any other reason other than what it was prescribed for.
    Question? why do they not treat each vet as an individual and why should I have to pay out of pocket for a service connected disability..?

  3. Darrell austin says:

    I’m a constituent of Mr Benishek. His hidden agenda is coming of age savings millions and taking pain medication from chronic pain patients will increase suicides ultimately reducing the role call. He is a veteran doctor that’s sitting in judgment of fellow doctors.

  4. ken darden says:

    There are two sides to each story!

    This new DEA policy in addition to the retirement of my long-term PCP caused my automatic renews to be cancelled.

    I am ok with this new rule; however, my new PCP decided not to renew my prescription until she sees me first. I have been on the same medication for 5 years which is vicodin.

    I did not learn of the retirement of my PCP until I had to go to the emergency room for severe muscle spasms in my back and sciatic nerve pain in left leg. I had a few pills left so I was given a muscle relaxer to go along with the vicodin and told to schedule an appointment with PCP asap for MRI.

    Now, I am in more pain, had oral surgery performed and not given medication because my record showed me receiving vicodin which was discontinued. Had to go to patient’s advocate to seek help, only to be told to go to emergency room for medication until scheduled appointment a month away. Emergency staff is not authorized to prescribe any type of NSAIDs so I received 2 shots for my pain and some Naproxen.

    There are many doctors working for the VA from Middle-Eastern countries that do not believe in giving strong pain medications and refuse to acknowledge disabilities due to pain.

    Ever wonder why so many VA disability claims are denied?

    Finally, Obama did not create this problem so please don’t go there!

  5. Paul says:

    I have used hydrocodone 10/325 for about 10 years and currently cut off as the VA runs around with their hair on fire trying to overdo compliance. Much of this came from Amy Goodman, aka Democracy Now. Who is she? She’s a left over from the antiwar movement people of the 60’s. In Nam from ’68-’70, I recall being painted as everything from a baby killer to drug freak after I got back. That all came from an orchestrated effort to punish Nam vet reputations. Now they’re doing it to new war vets! “they must all be weird in the head and druggies like their predecessors is the renewed message. Yes, some of my generation did “use” later as society itself turned to drugs. Heck, I only knew of 1 doper the whole time and he was sent back to CONUS for discharge in ’69. They say 270% increase OVER 10 YEARS!! The unspoken part is that new-era vets regained lost trust in the VA for a while and the number of enrollees swelled. Statistically, how many more vets were seeking care than before the “new” wars(s)started? My quality of life, productivity, and relationships improved after I started this course of pain management (no more than 4x day) and now I find that I’m back fighting anti-war hippies again after finding dignity and peace as I got older. Thanks DEA and VA. You had it right but now we must again suffer for transient, institutional political correctness. Bah!

    • jim says:

      hi i just replied to ray,i am in the same damn boat,and a lot of the decisions being made is (1) profiling,how many pain meds are you prescribed.(2) from that someone has developed a scale/chrt for a cut off on pain meds for vets,it is difficult to impossible to have any qulity of life with thier reduction of pain meds per month but, things for me aren’t getting better. trying to do psycial things around the house,i am finding myself getting mentally geared up for the task in hand and it is not getting done,after someone turns 50 things change, everything hurts alot more! vets need to somehow get together and organize and go before congress ,hope to hear back from you

  6. Ray says:

    I am a Vietnam PTSD disabled Vet. My pain medication that I have been taking for 15 years is being cut. My PTSD has not one thing to do with the physical pain issues I have. I have never abused, nor have taking more than prescribed. My pain issue’s,I will have for life,operations,theraphy,etc.. will not change this. At my age it allows me to function,bath,clean,cook,on and on. I do not get a buzz or high off my medication. So why is V.A. punishing all for the few bad, does not make any sense! We are being thrown in the same bucket for the abusers and what ever else the are doing with there pain medication. I personally will not live in pain for however many years of life I have-in which I hope is quite a number of many more years. Trust me I am not the only one that feels this way. There has been pain medication since the beginning of mankind. In other words what the HELL IS V.A. DOING TO US–TRYING TO INCREASE THE SUICIDE RATE! If I cannot take care of myself–BYE BYE–Thanks V.A. Best of Luck to all!

    • jim says:

      i understand exactly1!!! what you are saying. its happening to me and every time i spoke with nurses and providers i was lied to,from non cancer pain,testerone issues from tking the meds o when i am in my 90’s, also how there has been a “big mushroom” of,increased pain meds perscribed,well no shit we have beed at war for 10+ years,there has been a lots of military injuries! I THINK SOMEHOW THE VETS OF AMERICA NEED TO UNITE AND LET OUR VOICE BE HERD, especially pain meds it needs to be on a per vetern basis!.i hope to hear back from you

  7. Craig says:

    I was told today that my hydrocodone script was being cut off due to this insane nonsense. I have been taking opioids since 1989 for bilateral knee pain and lower back pain. My PCP told me I could check into a private pain mgmt clinic if I wanted meds or buy them off the street. I was told I was too overweight, 6’1″ 230lb. He also stated he didn’t want to be responsible if I drove and got into an accident and killed somebody while he was prescribing them to me. It’s all about the money. Once again the vets pay the price for this country’s freedom and neglected.

    • Linda says:

      My husband is being told these same things and that supposedly Congress has passed a new law just recently saying his and other vets pain meds are going to be cut off. Yet they are the only thing that make life bearable for him. Congress is supposedly suggesting that acupuncture and Yoga should be the replacement therapy. HA! He tried acupuncture years ago when he was nowhere near as in pain as he now is and it did him absolutely no good at all. Due to Spinal Cord Injury and surgeries, a bone on bone knee that needs replacement (that VA will not replace because of his high risk status, etc.) It is physically impossible for him to do Yoga so what in the world is supposed to control his pain? I have been unable to find this new “law” or how and to whom we need to address this ridiculous issue We have been told by VA doctors that this is a Nationwide law affecting ALL physicians both VA and civilian. If you or anyone else has that information, we would greatly appreciate it being posted. For vets or anyone else suffering something that will not require long term pain medication, this is one thing but for people who have pain all the time that is only lessened some by taking pain medications in higher doses, it is quite another! They are going to put them in a morgue if they actually do this! I agree 100% with you Craig! Doctors telling people to buy them off the streets? Well, isn’t that just about the most ridiculous thing I’ve ever heard other than the issue at hand!

  8. JUSTIN says:

    Question for all the Vets, I like you was told yesterday my script will no longer be filled after 7yrs and 4 doctors. No viable alternative to deal with the pain no help with withdrawls or side affects from the dependency so my question now is how many of your doctors are American citizens my new doctor is from India could barely communicate with me did not ask me one question about my pain my injury or why I have been taking the pain meds just said “we will no longer be refilling your pain med prescriptions”

  9. Robert says:

    This is why so many of us ends up buying drugs off the street. We give our lives for the USA and this is how we are treated. I am 64 and have a lot of pain, all of it comes from being in the Army and getting worse. Here it is 10:45 pm can’t sleep my pain is bad tonight, the VA took away my meds after 9 years, all I was taking hydrocodone , one at 6:00 and one at 3:00 just to move my body, I just can not believe they did this to US, I hope Trump will Man Up and stop this. Obama/Bush/Clinton told us to go to HELL. People might not like Trump but he said he was going to help us out like no other President did, it’s worth a chance . And no wonder so many vets drink.
    No wife, all my kids are gone. The only thing never left me is my PAIN.

  10. Bill Smith says:

    The problem with opioids is they do not treat long-term pain. Several studies show a lack of long-term efficacy. There is no study showing any long-term positive effects. The overdose numbers are not small. Opioids were not commonly prescribed for long term pain until the early 1990’s. Morphine was tried during and after the Civil War with the same problems as today. More pain, addiction, and overdose.

    Twice as many Americans have overdosed on opioids in the last ten years as died in the same ten-year stretch of the Vietnam War. Yes that is right opioids are a greater threat to Americans than the Viet Cong.

    The positive effects of opioids are nonexistent but the negative effects are certain. There is no such thing as “the right combination” If there was would you be complaing about your pain?

    I encourage all patients in pain to talk to their doctor. There are several treatments including physical therapy, chiropractor, acupuncture, pain injections, medications, and surgery.

    You will not get better by sitting at home and taking opioids. Multiple treatments not including opioids will be necessary to relieve your pain. You will have to do Physical Therapy in order to heal. Trying it a few times and complaining you hurt will not get your goals accomplished.

    You decide-Sit at home and take opioids or get proactive and work towards healing and getting better.

    Fact-Long-term opioid use leads to narcotic-induced hyperalgesia and decreased function of your body.

  11. Katherine says:

    As an NP in a state where hydrocodone is the #2 prescribed med in the state, I favor a revision in our practices as a country. Our community is flooded w lortab. Opiates are falling out of favor, because they kill people. Half of overdose deaths occur in a person that was never prescribed the offending medicine. At my clinic, this is a case by case decision, and veterans are not taken off of their pain medicines unless illegal substances are found in drug screening or evidence of misuse of the med exists.

  12. Frank Oliveras says:

    The biggest issue I see with having VA decrease over prescription of Opioids is they do not have a back up plan to wean off Veterans who have been taking this (and like) medication for a prolonged period of time. I was told when I requested a refill 2 years ago was “we are not refilling it anymore”… No taper off, just cold turkey and go figure out how to deal with withdrawals. When I asked them for options, my Primary Care Physician just requested a toxicology report… Nothing more… Having worked for the VA I can tell you there are some individuals who really care and try to go above and beyond for their patients just to be rewarded with negativity. Unfortunately, the system is designed to react to failures not to prevent them.

  13. Rob says:

    Now tell me what they do for degenerative dis disease? Caused by HCV which I got as a present for helping wounded vets. After 20 years or so they plan to take me off all my pain medication. Like it is ever going to improve. What part of degenerative do they not understand? No amount of P/T is going to work we started with that. I suppose a wheelchair then being put away until in some corner of a VA home then wait you expire is the option they want to see happen.

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