White House Action Increases Opioid Prescription Monitoring at VA

By Annette M. Boyle

WASHINGTON—The White House’s announcement this summer of new steps to address the prescription opioid and heroin epidemic had a mixed message for the VA: While the administration specifically praised the VA’s new opioid prescribing policies for healthcare providers, it also referenced the ongoing challenges in addressing opioid abuse among veterans.

In the aftermath of the July announcement, the VA has ramped up multiple programs to simultaneously better manage pain and opioid use.

“A number of changes in pain care delivery, which were already underway in VA, were both reinforced and accelerated by the president’s recent proposals,” said Lucile Burgo, MD, national co-director of the VA’s Post-Deployment Integrated Care Initiative and assistant clinical professor at the Yale School of Medicine in New Haven, CT. “These VA programs and initiatives were focused not only on addressing concerns related to opioid prescribing and addictions treatment, but also on shifting from pain care that relied heavily on potentially risk medications and procedures to pain care that was more ‘Whole Health’ oriented.”

Those programs include a new policy at VA that requires prescribers to check state prescription monitoring databases (PMDP) “at least annually when renewing or issuing a new outpatient prescription to continue therapy with a controlled substance, or anytime such a query is clinically indicated,” said Steve Hunt, MD, national co-director of the VA’s Post-Deployment Integrated Care Initiative.

Local policies might dictate that prescribers query the state PMDBs more often, however, Hunt told U.S. Medicine, which would be in keeping with guidelines established elsewhere. The Indian Health Service, for instance, requires prescribers and pharmacists to check the state PMDB every three months for opioid prescription renewals. Every state except Missouri has a PMDB, which enables prescribers to see whether patients are filling multiple prescriptions for painkillers from different physicians.

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