VA is developing an interdisciplinary, patient-aligned pain management system with the competency to provide safe and effective pain control and quality of life for Veterans for the remainder of their lives. One approach for accomplishing this is via academic detailing.
Academic detailing is a proven method in changing clinicians’ behavior when dealing with a difficult medical problem in a population. The method combines monitoring of prescribing, feedback to providers, and education and training in safer more effective, pain management. The Opioid Safety Initiative has been designed to integrate into the academic detailing model.
VA’s own data, as well as the peer reviewed medical literature, suggest that VA is making progress relative to the rest of the nation. In December 2014, a study by Mark Edlund, M.D., Ph.D,, and colleagues was published in the journal PAIN, the premier research publication in the field of pain management. This study reviewed the duration of opioid therapy, the median daily dose of opioids and the use of opioids in Veterans with substance abuse disorders and co-morbid chronic non-cancer pain. Edlund and colleagues found:
- First, half of all Veterans receiving opioids for chronic non-cancer pain are receiving them short-term (i.e., for less than 90 days per year);
- Second, the daily opioid dose in VA is generally modest, with a median of 20 Morphine Equivalent Daily Dose (MEDD), which is considered low risk;
- Third, the use of high-volume opioids (in terms of total annual dose) is not increased in VA patients with substance use disorders as has been found to be the case in non-VA patients.
Dr. Edlund and the other authors concluded “this suggests appropriate vigilance at VA, which may be facilitated by a transparent and universal electronic medical record.”
More Work to Do
While there is still more work to do, the results of VA’s ongoing efforts to better manage chronic pain are encouraging. For example, from July 2012 to June 2015 there were:
- 115,575 fewer VA patients receiving opioids;
- 38,163 fewer patients receiving opioids and benzodiazepines together;
- 86,932 more patients on opioids who have had a urine drug screen to help guide treatment decisions;
- 100,074 fewer patients on long-term opioid therapy;
- 13,731 fewer patients receiving greater than or equal to 100 Morphine Equivalent Daily Dosing; and
- 86 opioid overdose reversals resulting from VA’s education and rescue medication program.
It should also be noted that the desired results of the Opioid Safety Initiative have been achieved during a time when VA has seen an overall growth of 103,971 patients who have used VA outpatient pharmacy services.
Tom Cramer is a writer with the Department of Veterans Affairs. He has also written for the Departments of Justice, Agriculture and Health and Human Services. Prior to entering government service, he worked as a reporter on a daily paper in Virginia. He lives in Columbia, Md., with his wife Eileen.