The Albany Stratton Veterans Affairs Medical Center is trying to tighten protections against opiate addiction for veterans in the middle of a nationwide crisis.
The U.S. Department Veterans Affairs Office of the Inspector General released a report Aug. 1 that recommended non-VA health care providers being paid by the VA to provide services to veterans be required to submit opiate prescriptions directly to VA pharmacies.
According to the report, veterans are one of the highest risk pools of people to become addicted to opiates and that veterans could receive treatment in the form of opiates from non-VA doctors without regard for the possibility of co-occurring mental health problems.
“Veterans receiving opioid prescriptions from VA-referred clinical settings may be at greater risk for overdose and other harm because medication information is not being consistently shared,” said U.S. Department of Veterans Affairs Inspector General Michael J. Missal. “That has to change. Health care providers serving veterans should be following consistent guidelines for prescribing opioids and sharing information that ensures quality care for high-risk veterans.”
Peter Potter, director of public affairs for the Albany Stratton VA Medical Center, said the VA is trying to create a stronger system of sharing between the agency and pharmacies.
“We are trying to strengthen that relationship. There are ways for pharmacists to share prescription information,” Potter said. “It is very difficult because we cannot force veterans to get their pharmaceutical services through us.”
According to the report, more than 63 percent of veterans receiving more than 90 days of opioid treatment for pain from the VA also have a mental health diagnosis.
The VAOIG found that in 2016, 13,928 veteran patients were prescribed opioid medications totaling 85,729 prescriptions dispensed by health care providers paid for through the Veterans Choice Program or a combination of Choice and VA providers, which were filled in VA pharmacies. Of that number, 5,590 patients were prescribed opioid medications exclusively by Choice providers.
“I work with a few veterans who self-medicate. Most of the time it is alcohol, not drugs, but I find most of the time it is combat veterans who self-medicate,” said Command Sgt. Maj. Gary Flaherty, executive director of the Columbia County Veterans Services Department. “I think a lot of these kids coming back today are worse off then we did when we came back from Vietnam.”
Flaherty, who helps any veteran who asks to connect with services or deal with legal trouble, said he has only had three or four veterans he knows of who shopped for drugs.
“They go to the VA with pain and get prescribed something and then go to a private doctor to get more drugs for the same pain,” Flaherty said.
Flaherty said with the Choice Program private doctors should ask veterans if they are receiving treatment from the VA and what kind of treatment they are receiving from the VA.
“We ask veterans to ask their private doctors to provide information to us as precaution. They could possibly have a bad reaction if what a private doctor prescribes them and what we prescribe them are mixed,” Potter said. “Some patients choose not to and that’s fine.”
Potter said the VA automatically knows what veterans are prescribed through the Choice program, but co-managed care is another story.
“We have a tightly managed pain clinic that carefully reviews what the patient is suffering from and needs. It is very useful and successful,” Potter said. “Any opportunity we have to not use opiates, we try.”
Potter said the pain clinic program tests chronic patients periodically to make sure they have been taking the drugs they were prescribed.
“Some people may go out and sell the drugs,” Potter said. “If a patient comes and says they are still in pain, we test to make sure they are taking the drugs. If the drugs are in their system, then we decide if there is need to up the dose or look for other pain management opportunities.”
The Albany Stratton VA Health Center has its pharmacy, but local clinics have what Potter calls mini-pharmacies that are machines that have certain doses of certain drugs.
“Most veterans have their prescriptions mailed to them,” Potter said. In fact, 95 percent of our prescriptions are sent through the mail and veterans prefer that. And that means we can track controlled drugs, when they are delivered and when they arrive.”