Healthcare Inspection - VA Patterns of Dispensing Take-Home Opioids and Monitoring Patients on Opioid Therapy

As requested by the Senate Committee on Veterans’ Affairs, the VA Office of Inspector General assessed the provision of VA outpatient (take-home) opioids and monitoring of patients on opioid therapy. The population consisted of nearly half a million patients who were not receiving hospice/palliative care and who filled at least 1 oral or transdermal opioid prescription from VA for self-administration at home in FY 2012. The average and the median patient age was 59.4 and 61, respectively, and nearly 94 percent of them had been diagnosed with either pain or mental health issues and 58.4 percent with both. We determined that take-home benzodiazepines were dispensed to 7.4 percent of the study population, and 71 percent were dispensed concurrently with opioids. Take-home acetaminophens were given to 92.3 percent of the patients, and 2.0 percent of them were given an average daily dose that exceeded the maximum recommended daily dose of 4 grams. We found that 38.8 percent of the patients received medication management or pharmacy reconciliation. We determined that 6.4 percent of the new patients received both a urine drug test (UDT) prior to and a follow-up within 30 days of therapy initiation, that 37.0 percent of the existing opioid patients received both an annual UDT and a follow-up contact within 6 months of each filled opioid prescription, and that 10.5 percent of active substance use patients received both treatment for substance use and a UDT within 90 days of each filled opioid prescription. Even for the subpopulation of 19,724 active substance use patients who were on opioids for more than 90 days in FY 2012, we determined that only 18.8 percent of them received both a substance use disorder treatment in the FY and a UDT for each 90 days on opioids. We made six recommendations.