Review of Pain Management Services in Veterans Health Administration Facilities

The VA Office of Inspector General (OIG) conducted a healthcare inspection at the request of several members of Congress to assess pain management practices including opioid prescribing and the treatment of substance abuse at Veterans Health Administration (VHA) medical facilities. The OIG found that pain management services were offered at most VA medical facilities, and nearly all facilities offered substance abuse treatment using either methadone or Suboxone®. While the OIG was able to characterize the distribution of pain specialists and pain clinics in VHA, a staffing standard was not identified that would allow determination as to whether this pattern of staffing sufficed to meet demand for pain services. Of the more than 5.7 million VA patients (non-hospice/palliative care) with at least one clinical encounter in fiscal year 2015, the OIG found that 16.7 percent were dispensed opioids. The OIG observed that 93.9 percent of this population had been diagnosed with pain or mental health issues and 56.7 percent of patients with both. The OIG assessed the frequency of higher-risk groups including those veterans prescribed opioid doses greater than 200 morphine equivalents per day or those prescribed both opioids and benzodiazepines. The OIG also examined other practices that reduce the risk of opioid prescribing including the frequency of urine drug testing, use of non-opioid pain treatments such as psychosocial and integrative health, and substance abuse treatment. The OIG made 10 recommendations to the VHA Executive in Charge related to state prescription drug monitoring programs, the number of patients on chronic opioid therapy on a primary care provider’s panel, pain management specialists, pain assessment tools, complementary and integrative health services, urine drug testing, concurrent use of benzodiazepines and opioids, and medication reconciliation.