乌鸦传媒

ORLANDO -- Fewer veterans are taking opioids, thanks to an initiative across the Department of Veterans Affairs health system designed to diminish prescribing of the drugs, researchers reported here.

After the implementation of the in 2013, nearly a third fewer veterans received opioid prescriptions, falling from about 679,000 in 2012 to 471,000 this year, , of the Washington, D.C., Veterans Affairs Medical Center, and colleagues reported at the .

Sandbrink acknowledged an important caveat, however.

"The limitation of the OSI is that we only know about prescribing within the VA, and some veterans may have sought care outside the VA and receive opioid medications from other clinics," he said. "We do track pain severity, but functional outcomes are more challenging. We don't have those data here, but we are in the process of obtaining them."

One audience member said that "every veteran I've talked to who received care from the VA has had complaints about this system. They basically felt like they were being abandoned with this initiative."

The OSI was implemented in response to the opioid abuse epidemic, in order to reduce overprescribing of opioid analgesics for pain management and promote nonpharmacologic treatment options, particularly behavioral and complementary treatments, Sandbrink said. It included risk mitigation strategies such as informed consent for patients who would take opioids for longer than 90 days, doing urine drug screens at least once a year for opioid patients, checking a PDMP (prescription drug monitoring program) for multiple opioid prescriptions, and providing overdose education and naloxone distribution, with more than 60,000 naloxone kits dispensed system-wide.

The program also set up a "dashboard" that allows the VA to see all opioid prescribing within the system, providing feedback and identifying providers whose prescribing habits are "misaligned" with medical evidence.

Sandbrink and colleagues found that the proportion of patients receiving opioids during the survey period fell from 17.2% of all patients with any pharmacy activity to 11.6%. That proportion varied widely from center to center, but decreased to some degree in all of them, he noted.

The number of veterans on long-term opioid therapy fell from about 122,000 to 53,000 -- a 56% reduction, the researchers said.

Also, fewer patients were taking the particularly dangerous combination of opioids plus benzodiazepines, falling from some 438,000 patients to 281,000, for a 36% decrease. While about 14% of all opioid patients used to be on the combination, only about 8% were after the initiative was implemented, the researchers said.

"The Opioid Safety Initiative from the Department of Veterans Affairs is a comprehensive strategy to reduce reliance on opioid therapy and to expand access to non-opioid modalities," Sandbrink said.

He added that the VA and the Department of Defense just rolled out a , which will be incorporated into the OSI. The department will also begin to include functional assessments as part of the dashboard, and it is now in the process of figuring out the optimal assessment to use, he said.

"There's no evidence to think that the reduction in opioids has worsened pain care" for veterans, Sandbrink said. "Rather, at the same time opioids are being reduced, we are expanding access to non-opioid, non-pharmacologic care. We strongly believe that pain care for our veterans is getting better."

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