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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.
Moments before Army Staff Sgt. David Bellavia went back into the house, journalist Michael Ware said he was "pacing like a caged tiger ... almost like he was talking to himself."
"I distinctly remember while everybody else had taken cover temporarily, there out in the open on the street — still exposed to the fire from the roof — was David Bellavia," Ware told Task & Purpose on Monday. "David stopped pacing, he looked up and sees that the only person still there on the street is me. And I'm just standing there with my arms folded.
"He looked up from the pacing, stared straight into my eyes, and said 'Fuck it.' And I stared straight back at him and said 'Fuck it,'" Ware said. "And that's when I knew, we were both going back in that house."
Former Army Special Forces Maj. Matthew Golsteyn will plead not guilty to a charge of murder for allegedly shooting an unarmed Afghan man whom a tribal leader had identified as a Taliban bomb maker, his attorney said.
Golsteyn will be arraigned on Thursday morning at Fort Bragg, North Carolina, Phillip Stackhouse told Task & Purpose.
No date has been set for his trial yet, said Lt. Col. Loren Bymer, a spokesman for U.S. Army Special Operations Command.
John Wick is back, and he's here to stay. It doesn't matter how many bad guys show up to try to collect on that bounty.
With John Wick: Chapter 3 — Parabellum, the titular hitman, played by 54-year-old Keanu Reeves, continues on a blood-soaked hyper-stylized odyssey of revenge: first for his slain dog, then his wrecked car, then his destroyed house, then ... well, honestly it's hard to keep track of exactly what Wick is avenging by this point, or the body count he's racked up in the process.
Though we do know that the franchise has raked in plenty of success at the box office: just a week after it's May 17 release, the third installment in director Chad Stahleski's series took in roughly $181 million, making it even more successful than its two wildly popular prequels 2014's John Wick, and 2017's John Wick: Chapter 2.
And, more importantly, Reeves' hitman is well on his way to becoming one of the greatest action movie heroes in recent memory. Few (if any) other action flicks have succeeded in creating a mind-blowing avant garde ballet out of a dozen well-dressed gunmen who get shot, choked, or stabbed with a pencil by a pissed off hitman who just wants to return to retirement.
But for all the over-the-top acrobatics, fight sequences, and gun-porn (see: the sommelier), what makes the series so enthralling, especially for the service members and vets in the audience, is that there are some refreshing moments of realism nestled under all of that gun fu. Wrack your brain and try to remember the last time you saw an action hero do a press check during a shootout, clear a jam, or actually, you know, reload, instead of just hip-firing 300 rounds from an M16 nonstop. It's cool, we'll wait.
As it turns out, there's a good reason for the caliber of gun-play in John Wick. One of the franchise's secret weapons is a professional three-gun shooter named Taran Butler, who told Task & Purpose he can draw and hit three targets in 0.67 seconds from 10 yards. And if you've watched any of the scores of videos he's uploaded to social media over the years, it's pretty clear that this isn't idle boasting.
The Navy's electromagnetic railgun is undergoing what officials described as "essentially a shakedown" of critical systems before finally installing a tactical demonstrator aboard a surface warship, the latest sign that the once-beleaguered supergun may actually end up seeing combat.
That pretty much means this is could be the last set of tests before actually slapping this bad boy onto a warship, for once.
The Justice Department has accused Rep. Duncan Hunter (R-Calif.) of illegally using campaign funds to pay for extramarital affairs with five women.
Hunter, who fought in the Iraq War as a Marine artillery officer, and his wife Margaret were indicated by a federal jury on Aug. 21, 2018 for allegedly using up to $250,000 in campaign funds for personal use.
In a recent court filing, federal prosecutors accused Hunter of using campaign money to pay for a variety of expenses involved with his affairs, ranging from a $1,008 hotel bill to $7 for a Sam Adams beer.