Oversight Could Be Strengthened for Non-VA Healthcare Providers Who Prescribe Opioids to Veterans

Compared to the general population, veterans have a higher risk of opioid overdose due to many contributing factors, along with a higher incidence of medical conditions that increase the risk for opioid use disorder. The MISSION Act of 2018 requires VA to ensure that non VA providers who prescribe opioids to veterans receive and certify the review of VA’s Opioid Safety Initiative (OSI) guidelines. These guidelines require providers to query state prescription drug monitoring programs (PDMPs) to determine whether veterans already have other opioid prescriptions before writing a new opioid prescription. The VA Office of Inspector General (OIG) assessed whether VA ensured non VA providers were provided a copy of the OSI guidelines and certified that they have reviewed them, whether a sample of non VA providers conducted required PDMP queries, and whether sampled veterans’ medical records included opioid prescriptions, as required by the MISSION Act. The Office of Integrated Veteran Care (IVC) did not provide adequate oversight for either the third party administrators or non VA providers to ensure the providers received and certified they reviewed the OSI guidelines. IVC also did not monitor third party administrators to ensure non VA providers are completing PDMP queries as required. The sampled medical records generally contained the non VA provider opioid prescription information as required. However, this information was documented in different sections of the VA medical records, which may make it difficult for providers to access this critical information. The OIG made three recommendations to improve compliance with MISSION Act requirements and OSI guidelines.