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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.
‘I made promises to the people that I lost’— How the Iraq war forged a Navy SEAL’s path to Harvard Medical School and NASA
Navy Lt. Jonny Kim went viral last week when NASA announced that he and 10 other candidates (including six other service members) became the newest members of the agency's hallowed astronaut corps. A decorated Navy SEAL and graduate of Harvard Medical School, Kim in particular seems to have a penchant for achieving people's childhood dreams.
However, Kim shared with Task & Purpose that his motivation for living life the way he has stems not so much from starry-eyed ambition, but from the pain and loss he suffered both on the battlefields of Iraq and from childhood instability while growing up in Los Angeles. Kim tells his story in the following Q&A, which was lightly edited for length and clarity:
You can almost smell the gunpowder in the scene captured by a Marine photographer over the weekend, showing a Marine grunt firing a shotgun during non-lethal weapons training.
A Marine grunt stationed in Camp Lejeune, North Carolina is being considered for an award after he saved the lives of three people earlier this month from a fiery car crash.
Cpl. Scott McDonell, an infantry assaultman with 1st Battalion, 2nd Marine Regiment, was driving down Market Street in Wilmington in the early morning hours of Jan. 11 when he saw a car on fire after it had crashed into a tree. Inside were three victims aged 17, 20, and 20.
"It was a pretty mangled wreck," McDonell told ABC 15. "The passenger was hanging out of the window."
New Vietnam War movie 'The Last Full Measure' takes some well-deserved shots at the military’s award process
Todd Robinson's upcoming Vietnam War drama, The Last Full Measure, is a story of two battles: One takes place during an ambush in the jungles of Vietnam in 1966, while the other unfolds more than three decades later as the survivors fight to see one pararescueman's valor posthumously recognized.
With ISIS trying to reorganize itself into an insurgency, most attacks on U.S. and allied forces in Iraq are being carried out by Shiite militias, said Air Force Maj. Gen. Alex Grynkewich, the deputy commander for operations and intelligence for U.S. troops in Iraq and Syria.
"In the time that I have been in Iraq, we've taken a couple of casualties from ISIS fighting on the ground, but most of the attacks have come from those Shia militia groups, who are launching rockets at our bases and frankly just trying to kill someone to make a point," Grynkewich said Wednesday at an event hosted by the Air Force Association's Mitchell Institute for Aerospace Studies.