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The Best Effort To Fight Opioid Addiction May Be At This VA Hospital In The Center Of America’s Epidemic
Two months after President Donald Trump declared the opioid epidemic a public health emergency, the Department of Veterans Affairs became the first hospital system in the country to publicly release the rates of its opioid prescriptions. On Jan. 11, the VA uploaded the opiate prescription rates of 144 of its medical centers and clinics in an effort to increase transparency over how and at what volume the department administers the addictive pain pills.
Notably, the data revealed that 99% of all VA medical centers and hospitals saw a decrease in opiate prescriptions between 2012 and 2017.
But it’s in Ohio, one of the states hardest hit by the drug epidemic, where the VA has the lowest rate of opioid prescriptions: 3% for the Louis Stokes Cleveland VA Medical Center.
“We started a culture, if you want to it call that, of evidence-based tests and practices of opioids for over a decade,” Dr. Ali Mchaourab, the chief of medicine at the Cleveland medical center, told Task & Purpose. “We did that because we knew all along that these medications are not the answer.”
In 2012, the VA began taking steps to reduce opioid addiction among veteran patients by adopting initiatives that decreased the number of prescriptions and medications dispensed — reducing overall opioid prescriptions by 41% over the past five years. Those steps involve non-drug treatment options for chronic pain, such as acupuncture, spinal manipulation therapy, chiropractic care, and yoga; non-opioid treatment options, in the form of anti-inflammatory, antidepressant, and anticonvulsant medications; and the careful monitoring of opiate prescriptions. To put it another way, it’s not about just cutting prescriptions but offering alternative means to cope with chronic pain.
In addition to the VA-wide mandate, Mchaourab says that the drop in prescriptions at the Cleveland facility is due to a mix of available resources and educating care providers on how best to prescribe opioids.
“The number is low, not because we just focus on the numbers,” Mchaourab said. “It’s because our providers, from primary care to the most specialized, have so many tools and so many things available to them, including complementary alternative medicine, advanced technology, surgeries — anything and everything that’s available in science, is available at the Cleveland VA. And that subsequently led to opioid utilization coming down.”
Beyond its 13-strong pain management team — which also benefits from a robust support staff of nurses and techs — one of the biggest advantages patients and providers at the Cleveland clinic have is time.
“Embracing this philosophy requires a lot of time on the provider side, and as you know, anywhere you go [time] is a commodity,” Mchaourab told Task & Purpose. “Nobody can offer the time. … normally a patient is seen by a psychologist for 45 minutes and 45 minutes with a physician, because we want to take our time to understand the patient. We have a team of people to provide for the patient’s need, rather than seeing the patient quickly and providing a solution with a pill.”
The Cleveland medical center’s pain management program also uses teleconferencing to connect physicians with one another to stay on top of medical best practices and breakthroughs through weekly 90-minute training sessions. In a September 2017 editorial published in the online medical journal STAT News, Mchaourab notes that because opioid prescription rates vary widely across medical centers, and sometimes, even by “as much as threefold among providers practicing in the same hospital,” having a set of universally adhered to guidelines is crucial to curtailing the over-prescription of opiates.
“There are so many things that can be done other than being on a pill — but if that pill is needed, a low dose is needed, then we make sure that other things are being added as well so that his function and quality of life can be improved,” Mchaourab said. “And this is where safety and monitoring measures come into the picture.”
In 2016, illicit and prescription opioids were responsible for more than 42,000 fatal overdoses across the country. According to the Centers of Disease Control and Prevention, those numbers were five times higher in 2016 compared to 1999. Among veterans — many of whom were prescribed the highly addictive medication to treat chronic pain brought on by injuries incurred in military service — the numbers are more stark: They are twice as likely as civilians to die from accidental overdoses from the painkillers, Reuters reports.
But limiting opiate prescriptions across the VA is a tall order for a healthcare administration with more than 9 million patients — half of which suffer from chronic pain. Add to it that roughly 63% of all vets receiving chronic pain treatment also have a mental-health diagnosis, which can complicate a patient's treatment.
”There’s no way you can curb this problem by cutting patients off of medication,” Mchaourab said. “We don’t want them to feel judged because they’re on opioids. We’re successful because we want to provide them an alternative.”
If you are veteran being treated by the VA for chronic pain through prescription or alternative pain management and want to share your experience for future reporting, email me at James@taskandpurpose.com.
Five people have been indicted in federal court in the Western District of Texas on charges of participating in a scheme to steal millions of dollars from benefits reserved for military members, U.S. Department of Justice officials said Wednesday.
As the military services each roll out new policies regarding hemp-derived products like cannabidiol, or CBD, the Defense Department is not mincing words.
"It's completely forbidden for use by any service member in any of the services at this point of time," said Patricia Deuster, director of the Human Performance Laboratory at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
The warning, along with the policies issued recently by the Air Force, Coast Guard and Department of the Navy, comes as CBD is becoming increasingly ubiquitous across the country in many forms, from coffee additives and vaping liquids to tinctures, candies and other foods, carrying promises of health benefits ranging from pain and anxiety relief to sleeping aids and inflammation reduction.
The Navy has fired five senior leaders so far in August – and the month isn't even over.
While the sea service is famous for instilling in officers that they are responsible for any wrongdoing by their sailors – whether they are aware of the infractions or not – the recent rash of firings is a lot, even for the Navy.
A Navy spokesman said there is no connection between any of the five officers relieved of command, adding that each relief is looked at separately.
'We are a people organization' — Army leaders push renewed focus on soldiers amid rise in sexual assaults and suicides
After months of focusing on modernization priorities, Army leadership plans to tackle persisting personnel issues in the coming years.
Acting Army Secretary Ryan McCarthy said Tuesday at an event with the Foundation for Defense of Democracies that what people can to hear service leadership "talk a lot about ... our people. Investing in our people, so that they can reach their potential. ... We are a people organization."
Two U.S. military service members were killed in Afghanistan on Wednesday, the Resolute Support mission announced in a press release.
Their identities are being withheld pending notification of next of kin, the command added.
A total of 16 U.S. troops have died in Afghanistan so far in 2019. Fourteen of those service members have died in combat including two service members killed in an apparent insider attack on July 29.
Two U.S. troops in Afghanistan have been killed in non-combat incidents and a sailor from the aircraft carrier USS Abraham Lincoln was declared dead after falling overboard while the ship was supporting operations in Afghanistan.
At least two defense contractors have also been killed in Afghanistan. One was a Navy veteran and the other had served in the Army.