Pain management, addiction detection, and effective treatment are significant priorities for the nation’s veterans, and these objectives require better coordination of opioid and benzodiazepine prescribing inside and outside the Veterans Health Administration (VHA).
That’s what APA CEO and Medical Director Saul Levin, M.D., M.P.A., told the House Veterans Affairs Committee in a written statement about management of chronic pain and addiction to painkillers among veterans. The statement was in response to a House hearing titled “Between Peril and Promise: Facing the Dangers of VA’s Skyrocketing Use of Prescription Painkillers to Treat Veterans.”
Levin focused on veterans and the returning military population, but noted that issues such as medication diversion, medication seeking, improper prescribing, inadequate informatics on prescription utilization, and the need for better pain management and utilization of medical options to assist with substance use disorders are prevalent for the United States population as a whole.
He outlined four overarching recommendations: the use of prescription drug management plans (PDMPs) and the need for coordination between the (VHA’s PDMP and state-based plans, the need to recruit and retain more psychiatrists within the VHA, training the VHA workforce in evidence-based pain management and addiction treatment, and the need for new research on pain medications.
Coordination of state-based PDMPs and the PDMP being developed by the VHA is especially critical, Levin said. “APA has expressed concern that barriers to quality patient care as well as patient safety are the limitations in the VHA’s ability to monitor prescriptions written for veterans outside of the VHA system,” he told the committee. “Prescription data coordination can assist VHA physicians in identifying veterans who need intervention and treatment for substance use disorders as well as prevent intentional overdosing by alerting physicians to multiple prescriptions. . . . APA looks forward to the VHA’s PDMP system’s interoperability with state-run PDMPs. We note, however, that there are no national standards for state PDMP information sharing,” and such a lack “is a hurdle to overcome.”
For that reason, Levin urged that the VA enhance its collaboration with the Department of Justice, Department of Health and Human Services, and state attorneys general to expedite interoperability of the VA PDMP with state PDMPs.
Better training in pain management and addiction treatment also is critical, he said. “The utilization of pain medication without benchmark pain assessments and an accompanying treatment plan is inconsistent with good medical practice,” Levin told the committee. “Of particular concern is the prescription of multiple pain medications to veterans with multiple medical issues. Data suggest that some veterans with posttraumatic stress disorder (PTSD) experience pain at a more intense level than their counterparts without PTSD. . . . Many veterans being treated for opioid dependence also have co-occurring diagnoses such as depression or anxiety. Treatment of these co-occurring illnesses only underscores the need for more psychiatrists in the VHA.”
He added, “For opioid-addiction treatment options, APA strongly encourages the utilization of and more trained physicians, particularly by psychiatrists who are specially trained in the use of suboxone and buprenorphine in opioid-dependence treatment. These medications act as opioid antagonists and can assist in the supervised withdrawal from opioids.”
Levin noted as well that APA is a partner organization in two clinical mentoring and education initiatives funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). They are the Physicians’ Clinical Support System-Buprenorphine (PCSS-B) and the Prescribers’ Clinical Support System-Opioid Therapies (PCSS-O).
Through the SAMHSA-funded grant, APA has produced a series of webinars focused on the use of opioid therapies for treatment of opioid dependence and on the safe use of opioids in the treatment of chronic pain. ■