2015 Issues   /   September 2015

As Opioid Prescribing Drops, VA Expands Alternative Pain Therapies

By U.S. Medicine

By Annette M. Boyle

PHILADELPHIA — A year ago, the U.S. Drug Enforcement Administration (DEA) rolled out new restrictions on hydrocodone-based painkillers, creating a painful situation for many veterans.

The tightened controls classified the medications as Schedule II drugs, with the same restrictions as morphine, including requiring a written prescription and no more than a three-month supply without another doctor’s visit. At the same time, the VA faced significant congressional pressure to reduce the number of veterans receiving these opioids long-term.

In response, the VA stepped up its Opioid Safety Initiative, a program launched in 2013 to educate both veterans and providers about the risks and benefits of opioids and to use a multimodal, team approach to pain relief to minimize the need for opioids.

More than 50% of veterans receiving care through the VA experience chronic pain. Prior to the focus on reducing opioid use, about 1 million veterans received opioid prescriptions each year, and more than half became chronic users.1

U.S. Air Force Maj. Bradley Reyman, 509th Medical Operations Squadron physical therapist, wipes the ears of Col. Judy Stoltmann, 509th Medical Group commander, before administering auricular acupuncture last year. The VA now is training practitioners to use the pain control technique, which has been effective in the military. U.S. Air Force photo by Airman 1st Class Keenan Berry

Those numbers have dropped sharply. The VA reported in August that, since July 2012, the number of veterans receiving opioids has dropped by 115,575, and the number on long-term opioid therapy has declined by 100,074.

“Now we provide a comprehensive review with patients in groups, so they can ask questions and learn from each other, as well as from clinicians, about what pain is, the role of the brain, nerves and spinal cord and how stress activates the pain center,” said Rollin “Mac” Gallagher, MD, MPH, deputy national program director for Pain Management at the VA.

The role of patients in the treatment process also has changed, in keeping with the VA’s focus on patient-centered care. “Patients in pain are part of the decision-making team,” Gallagher told U.S. Medicine. “The emphasis is on self-management and the use of evidence-based complementary and integrative approaches such as yoga and acupuncture, which have a much better risk/benefit ratio than medications.”

The news media is replete with reports of war-wounded veterans who had been on hydrocodone-combination drugs for years, only to find out that their medications would not be renewed when they sought a refill. Disabled veterans organizations said they were deluged with complaints from members.

“Best I can tell, VA could have handled the change better and treated veterans affected with more compassion while they suffered through withdrawals,” Benjamin Krause, the creator of the DisabledVeterans.org community, wrote in a blog. “A big problem with the change was that VA failed to warn and did not explain exactly why they change was going on. Veterans that pushed for the painkillers they previously received were labeled as ‘drug seeking.’”

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