JGIM Supplement Features VA Research on Improving Opioid Safety among Veterans with Chronic Pain and Addiction
The opioid crisis is widely recognized as a leading public health crisis in the United States. Overdose deaths involving opioids, including prescription opioids, heroin, and illicitly-manufactured fentanyl analogues, took the lives of nearly 47,000 Americans in 2018, with 32% of those deaths involving prescription opioids. The rate of opioid overdose deaths among Veterans is double that of the general population. Accordingly, in the fall of 2019, VA HSR&D convened a state-of-the-art (SOTA) conference – “Effective Management of Pain and Addiction: Strategies to Improve Opioid Safety” – to develop research priorities for advancing the science and clinical practice of opioid safety, including both the use of opioid analgesics and managing opioid use disorder (OUD). A group of researchers and VA clinical stakeholders defined three areas of focus for the SOTA: 1) managing OUD, 2) long-term opioid therapy for pain including consideration for opioid tapering, and 3) treatment of co-occurring pain and substance use disorders. SOTA participants included VA and non-VA health services researchers, clinicians, and policymakers. Funded by HSR&D, this JGIM Supplement presents recommendations from the SOTA, as well as original research papers on opioid safety across the VA healthcare system.
Articles include, but are not limited to:
- Chang and colleagues report on the use of Evidence-Based Quality Improvement (EBQI) as a promising implementation strategy for expanding access to medications for opioid use disorder (MOUD) in primary care settings, where the capacity to expand needed treatment is greatest.
- Frank and colleagues highlight the clinical and policy recommendations related to MOUD – and propose reducing barriers to MOUD access through measures such as reducing classroom hours required by the Drug Enforcement Agency to prescribe buprenorphine, as well as allowing expanded telehealth options for engaging and retaining patients in MOUD. With its nation-wide Video Connect system, VA is well-positioned to respond to access challenges deepened by the COVID-19 pandemic.
- Morasco and colleagues explored factors associated with dose increase in long-term opioid therapy, a key to preventing the number of patients who require a taper in the first place.
- Manhapra and colleagues propose a new diagnostic entity for patients on long-term opioid therapy for pain who have symptoms of dependence but no clear OUD diagnosis.
The editors for this Supplement were: William Becker, MD, HSR&D’s Pain Research Informatics, Multi-morbidities, and Education (PRIME) Center; Keith Humphreys, PhD, HSR&D’s Center for Innovation to Implementation (Ci2i); and Marianne Matthias, PhD, HSR&D’s Center for Health Information and Communication (CHIC).
Summary: Recommendations from the SOTA on Opioid Safety support VA's leading role in defining integrated, patient-centered management of pain, opioid tapering, and treatment for OUD. Along with ongoing large-scale initiatives for increasing access to MOUD, they will lessen the impact of the opioid epidemic on the Veteran population and also provide lessons for non-VA care.
Effective Management of Pain and Addiction: Strategies to Improve Opioid Safety. Journal of General Internal Medicine. December 2020;35(Suppl 3).