Mounting a Scientifically Informed Response to the Opioid Crisis in the Veterans Health Administration
- PDF / 148,243 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 40 Downloads / 174 Views
Mounting a Scientifically Informed Response to the Opioid Crisis in the Veterans Health Administration William C. Becker, MD,1,2, Keith Humphreys, PhD3,4, David Atkins, MD, MPH5, and Carolyn M. Clancy, MD6 1
Pain Research, Informatics, Multimorbidities & Education Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, USA; 2Yale School of Medicine, New Haven, CT, USA; 3HSR&D Center for Innovation to Implementation, VA Palo Alto Heath Care System, Palo Alto, CA, USA; 4 Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA; 5VA Health Services Research & Development, Washington, DC, USA; 6Department of Veterans Affairs, Washington, DC, USA. J Gen Intern Med 35(Suppl 3):S883–S5 DOI: 10.1007/s11606-020-06349-1 © Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2020
at least 2012, the opioid crisis has been widely S ince recognized as a leading public health crisis in the USA. Overdose deaths involving opioids, including prescription opioids, heroin, and synthetic opioids (i.e., fentanyl), claimed the lives of nearly 47,000 Americans in 2018, with 32% of those deaths involving prescription opioids.1 Opioid use disorder (OUD) has had an even greater impact among Veterans,2 where the rate of overdose deaths is double that of the general population. The risk for opioid use disorder—defined as the compulsive taking of opioids despite harm—also is higher among Veterans than the general public. This is partly because patients who receive care in the Veterans Health Administration (VHA) have a high rate of comorbidities that contribute to the incidence and severity of OUD—including major depression, post-traumatic stress disorder (PTSD), and chronic pain. The association between chronic pain, prescription opioids, and OUD is complex and unpredictable, and at the public health level a clear trajectory has emerged over the last 25 years. Over that period, opioid prescribing quadrupled in the USA, most of it for chronic, non-cancer pain conditions. What followed seems tragically inevitable through today’s lens: a marked rise in OUD incidence and prevalence and an increase in non-fatal and fatal overdose as OUD led to the over-consumption of prescription medications and a transition to higher potency formulations and routes of administration. Most recently, this includes the use of illicitly manufactured fentanyl analogs—the highest potency opioids in history. VHA responded early to the opioid crisis. In 2013, VHA established a system-wide effort called the Opioid Safety Initiative3 including programs to expand non-opioid alternatives for pain, such as complementary and integrative treatments and behavioral therapies. Most of the decline in prescribing was due to sharp drops in the numbers of patients started on opioids,
thereby reducing addiction and overdose long-term. However, overall reductions in opioid prescribing within VA did not reduce fatal overdoses or suicides amo
Data Loading...
