VA is developing an interdisciplinary, patient-aligned pain management system with the competency to provide safe and effective pain control and quality of life for Veterans for the remainder of their lives. One approach for accomplishing this is via academic detailing.

Academic detailing is a proven method in changing clinicians’ behavior when dealing with a difficult medical problem in a population. The method combines monitoring of prescribing, feedback to providers, and education and training in safer more effective, pain management. The Opioid Safety Initiative has been designed to integrate into the academic detailing model.

VA’s own data, as well as the peer reviewed medical literature, suggest that VA is making progress relative to the rest of the nation. In December 2014, a study by Mark Edlund, M.D., Ph.D,, and colleagues was published in the journal PAIN, the premier research publication in the field of pain management. This study reviewed the duration of opioid therapy, the median daily dose of opioids and the use of opioids in Veterans with substance abuse disorders and co-morbid chronic non-cancer pain.  Edlund and colleagues found:

  • First, half of all Veterans receiving opioids for chronic non-cancer pain are receiving them short-term (i.e., for less than 90 days per year);
  • Second, the daily opioid dose in VA is generally modest, with a median of 20 Morphine Equivalent Daily Dose (MEDD), which is considered low risk;
  • Third, the use of high-volume opioids (in terms of total annual dose) is not increased in VA patients with substance use disorders as has been found to be the case in non-VA patients.

Dr. Edlund and the other authors concluded “this suggests appropriate vigilance at VA, which may be facilitated by a transparent and universal electronic medical record.”

More Work to Do

While there is still more work to do, the results of VA’s ongoing efforts to better manage chronic pain are encouraging. For example, from July 2012 to June 2015 there were:

  • 115,575 fewer VA patients receiving opioids;
  • 38,163 fewer patients receiving opioids and benzodiazepines together;
  • 86,932 more patients on opioids who have had a urine drug screen to help guide treatment decisions;
  • 100,074 fewer patients on long-term opioid therapy;
  • 13,731 fewer patients receiving greater than or equal to 100 Morphine Equivalent Daily Dosing; and
  • 86 opioid overdose reversals resulting from VA’s education and rescue medication program.

It should also be noted that the desired results of the Opioid Safety Initiative have been achieved during a time when VA has seen an overall growth of 103,971 patients who have used VA outpatient pharmacy services.

Tom CramerTom Cramer is a writer with the Department of Veterans Affairs. He has also written for the Departments of Justice, Agriculture and Health and Human Services. Prior to entering government service, he worked as a reporter on a daily paper in Virginia. He lives in Columbia, Md., with his wife Eileen.

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Published on Aug. 7, 2015

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  1. Chief_Beavers August 17, 2015 at 12:38 pm

    I feel like I am being bullied by a nurse at VAMC Battle Creek about pain meds. I was just informed by her that I was not going to get refills for Tramadol until I gave a urine sample and signed a Pain Contract. I had never been informed of a Pain Contract. The VA needs to advertise this contract in a mailing with prescriptions or at appointments when these are prescribed. I had an appointment in April 2015, now 4 months later I’m told about a Pain Contract. Why was I not told about this or asked to sign one at this appointment.
    I went to the CBOC in Lansing to give a urine sample. The urine sample has no security or Chain of Custody. It was placed in the little door in the wall at the Lab along with 5 other samples. If this urine sample is for something as important as drug screening then it needs to be kept secure and tracked just like on Active duty.

  2. Edward Mcdonald August 10, 2015 at 12:15 am


  3. Michael S. Jarrett August 7, 2015 at 5:56 pm

    Mr. Cramer, I see that you write for VA and I assume you also get paid by VA to write thes articles.
    Well sir I read this article 3 times to make sure I understood it. I also see where you stated that “the desired results of the Opioid Safety Initiative have been achieved”.. I would like to know exactly what the desired results of the OSI are ?
    Also, I understand you write for VA, but aren’t the veterans part of the VA ? So how about you speak to veterans who are involved in the OSI and get their perspective on this program ?
    Then after doing so write a transparent article about their experiences with the OSI program.

  4. Michael S. Jarrett August 7, 2015 at 5:31 pm

    I am currently in the OSI at Indy. I have to say this first, the nurse practicioner is very detailed in her evaluation and preparation for care of my pain issues and even more. I am skeptical of the entire OSI program and the intent of it overall.
    Yet with that said, I was sent for acupuncture treatment for 8 sessions. After the 8th treatment any further treatments were denied even though I was getting some relief from them with pain and severe muscle spasms. I was informed by the NP prior to treatments that they were not intended to be a long lasting treatment. And that if I wanted to continue on with acupuncture I would have to use my insurance or pay for it out of my pocket. During my care so far my opioid intake has been reduced and will most likely continue to be reduced.
    I don’t have a problem with doing treatments but when you begin to get some relief from it and then it is stopped you just go back to where you were prior to the treatments ! Makes NO SENSE AT ALL and makes a person feel as if you are being tortured to take this path of care. I am not sure where things go from here but I DO NOT HAVE ANY CONFIDENCE IN THE OSI PROGRAM AT ALL !!
    I can only imagine how many veterans are suffering from severe pain even after being made to be involved in the OSI program ! Yes I said made to be in the OSI program. I was told, along with 7 other veterans that if we did not participate our primary care physicians would not treat us any further and our VA care could be in jeopardy!

  5. William T Rogan August 7, 2015 at 11:18 am

    The other side of this is that the VA is more concerned with controlling drugs and their image that they are in controlling some patients pain. There are people that need these meds and they are being treated like criminals. Read the contract patients must sign to get their medication.

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