Through VA’s Diffusion of Excellence Initiative, innovators are helping VA prevent Veteran opioid-related deaths by making it easier to deliver life-saving medication.

Opioid overdoses take the lives of thousands of Americans each year, claiming nearly 30,000 in 2014 alone. To complicate matters, Veterans are twice as likely to die from accidental opioid overdose than non-Veterans.

Fortunately, there is a drug, Intranasal Naloxone, known as Narcan, that can effectively reverse opioid overdoses. But Narcan is not typically available at the time of an overdose. A Boston VA Health Care System employee saw an opportunity to improve reaction time, by training nearly 700 Veterans, staff members and VA Police to administer Narcan. They also made Narcan readily available in automated external defibrillator cabinets placed throughout the facility so staff could access it quickly.

IMAGE: Pamela Bellino-Rivera, director of patient safety at the VA Boston Health Care System worked with Steve Elliot, VISN 8 chief of police, to ensure wide-spread availability of Narcan to help save lives.

Pamela Bellino-Rivera, director of patient safety at the VA Boston Health Care System worked with Steve Elliot, VISN 8 chief of police, to ensure wide-spread availability of Narcan to help save lives.

Boston VA’s Pam Bellino-Rivera submitted this practical solution and has overseen its implementation at all Boston sites – Jamaica Plain, West Roxbury, Brockton and the region’s outpatient clinics.

“We saw a number of events where patients were experiencing an opioid overdose,” she said. “There was a delay in administering Narcan while waiting for the ambulance or the medical team to arrive. We needed first responders to have Narcan readily available.”

The results? Since 2014, 98 Veteran lives have been saved as a result of this practice.

Bellino-Rivera’s idea is an example of how VA’s Diffusion of Excellence Initiative not only gives VA employees a forum to suggest solutions, it provides an avenue to spread the best practices from their facilities to VA medical centers across the nation.

Through the Diffusion for Excellence effort, VISN 8 was selected to implement the practices and they are in the process of implementing it across VISN 8.

IMAGE: Diffusion of Excellence logo depicting a sharkVA Secretary Dr. David Shulkin created the initiative during his tenure as undersecretary for Health, to identify and disseminate promising practices, as well as standardize those that promote positive outcomes for Veterans systemwide. The initiative empowers employees to share innovations and drive a supportive culture of continuous improvement.

Since its inception, VA has identified more than 1,000 practices submitted by front-line staff to address health care priorities of improving access, care coordination, employee engagement, quality and safety, and the Veteran experience.

The initiative continues to foster department-wide innovations that can quickly spread from idea to reality in VA facilities across the country not only to meet the needs of Veterans but possibly save their lives.

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Published on Jun. 19, 2017

Estimated reading time is 2.2 min.

Views to date: 190


  1. larry thompson June 25, 2017 at 3:41 pm

    Ive been taking opiates for 20 plus years for pain with no increses. They decide there is a problem and 50% redution with promises of futher cuts. If I go to a drug clinic I will get 4 times as much as I curently take. But I have to fail a drug test. Why dont you all just keave sucess alone. Ive never asj for more so you expect me to take less. I dont get it

  2. ROSendo Gaytan June 24, 2017 at 6:47 am

    What is really going on at the VA with pain Med’s?
    Seem Public Opinion over-rides the needs of the VET’s who need these meds on daily basis for a better quality of life, AND don’t abuse them. As a urine test is required and I support, to detect the mixing of drugs.
    Myself, suffer from lower back pain many years while on Active duty, given physical therapy, temp PT profiles, muscle relaxers, nothing worked effectively. Then 2 years prior to retirement (2002) was prescribed Vicodin; pills were counted and counseling, no issues. Then the back spine injections followed. Both worked for me…. My Quality of life improved.
    Then January 2017 my VA doctor (ATLANTA-Ft. McPherson clinic) BAM! Med’s were cut off. With 15 years of no abuse, clear urine test, no domestic issues, etc, nada!! Seems Doctors are pressured by public opinion NOT the VET’s needs.
    Reading these Post some VET’s will seek help/ relief, some legal, some not, some just have no choice, sad, but truthful…

  3. rdrwilde June 24, 2017 at 4:05 am

    I’ve been in pain for years my back type 2 diabetes other stuff, the VA cut me off of all my pain meds. I’m lucky I see a pain doctor threw Choice if it wasn’t for that I think I’d be dead know.

  4. Daniel Santos June 24, 2017 at 12:41 am

    It’s very strange that the fantastic VA system talks about opioids overdose. I have been dealing with pain for over 40 years. I was doing fine until I got this new PCP. SHE STOPPED ALL PAIN MEDS BECAUSE SHE THOUGHT I WAS ON TO HIGH OF A DOSE, 105mg of Oxy a day. She never talked to me she never even set an appointment. She even held my meds hostage, she told me watch this video on Narcan then she would reinstate part of my meds. The clinic director at the VA clinic moved me to another doctor. When we went in to talk face to face all he could do is laugh at everything we brought up as for my health issues, he laughed when my wife tried to talk and he laughed. I was so pissed that we stormed out of his office. I raised this issue with the same clinic Director and I got moved to a PA when I asked for a real doctor.

  5. Stan Riedel June 23, 2017 at 8:52 pm

    Just like a lot of people. I have been warehoused by the VA. The North Vietnamese could cripple us but the VA and a congressman sure did. They give you an ice bag after surgery now, and tell you to learn to live with it. Our quality of life without some pain relief is next to nothing. Didn’t have any problems for the 10 years I had oxy. Documented pain patients should have a pass on the witch hunt for abusers. I use to be able to stand up straight like everybody else. Now I am confined to a recliner 24/7, while the righteous doctors and congressmen pat themselves on the back for the great job they are doing. Now they are asking a bunch of untrained employees what they think should happen with pain patients. Great job, you losers. Wait until it is your turn to suffer in silence.

  6. Harry Fincham June 23, 2017 at 8:38 pm

    I read the article above on Narcan. It appeared that only the VA centers in Boston was going to have Narcan on hand. It helps so much on overdoses that it should be available at all VA centers. I hope that I misunderstood the article.

  7. Paul Coleman June 23, 2017 at 6:58 pm

    I’m Service Connected for both knees and lower back and asked ortho clinic for something to help with the pain and doctor said no because I might get addicted.

    On the into the hospital for my appointment at the VAMC in Little Rock, Arkansas a man asked if I wanted to buy an 8-ball ( 1/8 ounce) of heroin for $125.00 ( which is cheap). This was in the VAMC’s parking lot at about 9am in the morning.

  8. Edward c rice June 23, 2017 at 5:18 pm

    I’m with the the guys that have a chronic pain situation.I was able to get hydrocrodone 10 for my pain just 1 month ago.NowI must be so much of a user,that they will no longer give me the pain med.I use medicine as it is prescribed.I have neuropathic pain and have tried all the brain meds from gabapentin to lyrica these meds dont work for me.I was told by the para at the clinic that HE does not prescribe narcotics.I stated that I will suffer in pain,HE said I’ll prescribe for you Ibuprofen.This drug turns my urine dark redish orange,I told him .HE turned his bank and walked away.

  9. Victor Sellers June 23, 2017 at 3:39 pm

    This is a crock the GOVERNMENT created to cut costs. The VA is fasing out all medicine in favor of acupuncture being used to cure everything, in case you haven’t noticed all the doctors are from India. They are cutting your prescriptions in half where ever they can, and at least half of them have one goal, bring you over to Hari Krishna and away from modern medicine. They want you to believe in caveman medicine because it’s cheap and requires no education. Practitioners in India look at charts and work on people. I think it’s the most disgusting practice pulled over on the vets to date.

  10. David Ramer June 23, 2017 at 2:44 pm

    Oh yes I forgot to mention that I’ve been taking opiates for over 20 years with no problems

  11. David Ramer June 23, 2017 at 2:42 pm

    I’d like to add my two cents I’m rated at 90% my VA doctor says in wrote I cannot work the VA Administration says I can three and a half years ago they cut my pain medicine in half laughed and said live with it oh by the way get a job unable to work I’ve lost my savings and maxed out my credit card and I’m running out of money time in patient although I have a lot of good going on in my life I’ve never tried marijuana but each day it gets closer and closer to just use it along with suicide each day it gets closer and closer and it’s because of the pain I’m in and the frustration for the VA and no relief I had relief

    • Matthew Neely June 23, 2017 at 4:26 pm

      David, have you applied for IU (Individual Unemployability)?

  12. David Emerson O'Mara June 23, 2017 at 2:10 pm

    Once again and again and again the honest men and women who “always” follow the rules get the shaft for people who don’t follow the rules. This goes on and on and on.
    Will it ever stop?

  13. Daniel Like Lasater June 23, 2017 at 12:22 pm

    I been in Pain for 4 years since I came into the VA System from the Civilian side because I lost my Health Insurance. I can’t get any Pain meds. I’ve been poked , MRI’d injected, electrofied, Still no pain meds. I lost count how many Doctors I’ve seen. I have 3 bulging discs, chipped L-3 verbera, L-2-3 I have no disc L4-5 No Disc. How Hard is this to Diagnose Doctors ? My Pain Affects my Right leg ,I can’t walk at times , My pain level is at 8-10 at all times. I can’t sleep because of the Pain.
    It’s to get dressed , I can’t stand too long , I can’t walk too far , I can’t bend over , I can’t go up stairs , I can’t get dressed on the Right side. The Meds I’m on I sleep most of the Day but in Pain. 4 Years of Pain I’m Tired of It. There’s some of Us who need the Pain Meds and what you’ve done is hurt us, thanks.

    • Robert Daley June 23, 2017 at 2:32 pm

      You can get narcotics through the VA. I do and my primary is an NP. Hydrocodone 4x a day , muscle relaxers and gabapentin. L3-s2 degenerative, spinal stenosis, both sciatic nerves compressed, constant pain, RA in back. Your primary can give you lower levels of narcotics before sending you to pain management

  14. Jon June 23, 2017 at 12:10 pm

    Veterans should get a voucher to the gym of their choice, stipend for work-out clothes, and supplied a professionally qualified medical trainer to help with our issues and health. Maybe all the clinics could even start a health club or group. Veterans tend to do better around eachother instead of sometimes “seemly careless civilians”. We also need more attention from doctors visits and check ups. As for the claim process putting it mildly, it sucks. We need a better way to identify “critical cases” and service them first. No veteran should be “waiting in the dark” wondering if their case was forgotten. The mindset is “we can’t help them all” but the fact is we can try a lot better. ODS Vet

  15. Kim Danek June 23, 2017 at 11:28 am

    You have a typo in the first sentence of your third paragraph. “Fortunately, there is a drug, Intranasal Naloxone, know as Narcan, that can effectively reverse opioid overdoses. But Narcan is not typically available at the time of an overdose.”

    It shoudl read “Fortunately, there is a drug, Intranasal Naloxone, KNOWN as….”

    We would also like to consider reprinting this article in another federal newsletter. Is there someone I can contact?

    • Megan Moloney June 23, 2017 at 12:36 pm

      Kim, please send us a request and contact information at

  16. Devin June 23, 2017 at 11:17 am

    @ Matthew Neely depending on your regional office appeals can take 1-3 years, then to the VA Board of Veterans Appeals, that can take 3-7 years… So its just waiting nothing can be done. This is your time to gather more evidence. If you want you can call your power of attorney over your claim (VFW, American Legion, AMvets Etc.) If you want a new VSO find one. . Good luck. -A VSO

    • Matthew Neely June 23, 2017 at 11:28 am

      I know the time frame Devin. I am past the 3 year mark at the RO already. I cannot even submit the evidence I have because it isn’t accepting anything from me or my VSO. My VSO has already contacted the VA on why it isn’t moving and they refuse to reply to her about this either.

  17. Roger Brewer June 23, 2017 at 11:09 am

    Maybe it’s my generation, but I’m not taking cannabis, even though I’m roughly 1 hr away from CO. Every few years there’s a crackdown on opioid usage. Like the guy above who has severe knee pain and can’t get relief. I take 30 mg MS Contin twice a day, 20 mg oxy as needed, 20 mg diazepam as needed, and ~100 mg tramadol. That doesn’t even count the antidepressants. I do have Narcan, my wife knows where it is – unlike all my narcotics, it’s not locked up. People need to function, and until something better comes along, opiates help us function with severe chronic pain.

  18. Kathleen McGreal June 23, 2017 at 10:23 am

    Not only should cannabis be prescribed by the VA for PTSD but for chronic pain and other health issues. Jeff Sessions must have had a bad trip in the 60’s.

    • Dewey Rhoden June 25, 2017 at 7:55 pm

      I asked my Primary Care Doctor that if medical Cannabis was made legal in my state would she prescribe it…. her answer “hell no”. So there you go, i can only assume unless it is made legal from a Federal perspective the VA won’t ever do it and even then you have doctors like mine who says regardless if its legal or not she still would not prescribe it.

  19. Steve Russell June 22, 2017 at 6:46 pm

    Myself and several other Veterans I know were simply cut off without warning. I am a disabled Veteran with a service coned knee replacement . I finally got the knee replaced after living in pain for years . Now I don’t even deserve to have any pain relief , guess I am doomed to live in pain and sit at home. .

    • Matthew Neely June 23, 2017 at 11:24 am

      Joe, thank you for your suggestion. However, my Congresswoman is useless. I have been waiting to hear back from their staffer (who is never in the office or answers the phone) for 5 months. The VA directly is my last resort before I go to the media.

      • David Brooks June 28, 2017 at 12:52 pm

        Have you tried your Senator or your State representatives they can sometimes get your congress rep to respond. Also have you contacted the DAV they can work miracles sometimes. Don’t give up be the biggest thorn in your congresswoman’s behind call anyone and everyone that might be able, GOOD LUCK and just don’t give up that is what they want.

    • Dennis Savage June 23, 2017 at 11:56 am

      Since when are opioids dispensed by the VA? I have to see a pain management doctor on my dime to get the pain relief I need. I am 61 years old. Why should a bunch of dumb asses who don’t follow the dispensing instructions and od, good. We don’t need them anyhow. I have been taking pain meds for 30 years with no ill effects, yet now I have been cut back tremendously by the ignorant DEA, FDA and the CDC. I plan on killing myself this year as I can not live (you call this living?). Maybe if enough people “martyr” themselves for this reason, things may change.

    • Philip Richie June 23, 2017 at 7:53 pm

      Same thing happened to me. Forced me to go through withdrawal with no help. Now just live with the pain. I hope the bastards that make these decisions will suffer the same fate! I hate the M’s!

    • JAMES DEUEL June 24, 2017 at 1:59 pm

      Southeast TX VA Medical? region cut everyone except terminal cancer patients without examination or much warning. Then they had the gall to lie like dogs and say the DEA ordered them too. If it was tue it would be clear cut Malpractice for a Dr to let a Beaurocrat tell them how to practice medicine. Of course its a lie for CYA purposes, thinking no one would question it.

      The DEA said “We don’t tell doctors what or how to prescribe. We did warn all doctors that we were monitoring opioids and would question excessive use.” So 4 months later they send me to the pain specialist in Houston, MDVAMC, and they claim The CDC ordered it. Another bald faced lie. Over 20 yrs of pain relief cut off with a smile.

  20. Matthew Neely June 22, 2017 at 5:48 pm

    I know this isn’t the place, but no applicable blog postings have the comments still open.

    Why has my appeal, filed 6/12/2014, done nothing? Status shows they received it but that is all. In over 3 years, nothing. I can’t even upload documents. I read a blog from LAST YEAR stating they were working on claims from July 2014. Yet nothing on mine.

    I have diagnosed fibromyalgia (diagnosed by a civilian doctor and confirmed by the C and P) along with other gastro issues, and others. Along with 2 qualifying deployments to the Persian Gulf/Red Sea making it a Southwest Asia Service. Yet denial. Meets every requirement listed in 38 CFR 3.317.

    Now the appeal is sitting there being ignored by the VA. I have a VSO and she can’t even get anything done on it.

    • Joe June 23, 2017 at 10:37 am

      Contact your congressman or congresswomen. They will be able to assist you in getting this resolved or get you answers.

      • Matthew Neely June 23, 2017 at 4:27 pm

        Joe, thank you for your suggestion. However, my Congresswoman is useless. I have been waiting to hear back from their staffer (who is never in the office or answers the phone) for 5 months. The VA directly is my last resort before I go to the media.

    • Devin June 23, 2017 at 11:17 am

      @ Matthew Neely depending on your regional office appeals can take 1-3 years, then to the VA Board of Veterans Appeals, that can take 3-7 years… So its just waiting nothing can be done. This is your time to gather more evidence. If you want you can call your power of attorney over your claim (VFW, American Legion, AMvets Etc.) If you want a new VSO find one. . Good luck. -A VSO

    • Philip Richie June 23, 2017 at 7:50 pm

      I hear your pleas. My claim was filed in April 2007. Denied, appealed, returned to area of jurisdiction, denied, gone to VBA, returned again and still waiting after ten years.
      Good luck!

    • Dewey Rhoden June 25, 2017 at 7:40 pm

      Congressman or woman is the best route, I called mine and they wanted me to provide the long form of the denial from the VA. i called the VA and requested the long form of my denial i said to them “having spoken with my Congressman about why my presumptive conditions that i have been treated for with 22 years of medical records to back it up was denied, my Congressman needs a copy of my denials”. I kid you not, the next week i received a date for my appeal hearing. The day before my hearing my Rep called and said no need to make the trip the VA understands they have made a mistake. I am still waiting for a final word as to my rating but hey that is still huge progress.

  21. Robert Heurung June 21, 2017 at 11:20 pm

    An even better way to reduce opioid deaths is cannabis.
    Veterans can share innovations and drive a supportive culture of continuous improvement also.

Comments are closed.

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