Pubdate: Sat, 24 May 2014
Source: Tampa Bay Times (FL)
Copyright: 2014 St. Petersburg Times
Contact: http://www.sptimes.com/letters/
Website: http://www.tampabay.com/
Details: http://www.mapinc.org/media/419
Note: Named the St. Petersburg Times from 1884-2011.
Author: Stephen Nohlgren, Times Staff Writer
Page: A1

POOR USE OF MEDS AT VA

Hospitals Nationwide Are Mismanaging Chronic Pain, A Study Says. It's 
Less So Here.

With VA hospitals already under scrutiny for forgoing care and 
falsifying records, a new report faults the U.S. Department of 
Veterans Affairs for mishandling narcotic painkillers.

VA medical centers routinely violated their own protocols while 
prescribing opioid drugs to about 450,000 veterans in 2012, the VA 
inspector general reported.

Doctors failed to conduct mandatory urine screenings. Patients 
refilled prescriptions early with impunity. Veterans combined 
narcotics and other powerful drugs - and six out of 10 patients on 
painkillers had mental problems or a history of abusing drugs.

Narcotic painkillers 'can cause serious harm, including overdose and 
death," the report said. 'Patient adherence with the proper use of 
opioids is crucial." Andrew Kolodny, president of Physicians for 
Responsible Opioid Prescribing, said the report reflects a nationwide 
epidemic of narcotic use for chronic pain, but also a failure within 
the VA to enforce proper precautions.

'Vets are at high risk of chronic pain injuries suffered fighting 
overseas, and opioids are highly addictive," Kolodny said. 'The 
overdose rate within the VA system is twice the national average." 
The inspector general report provided no statistics for individual 
hospitals, but patients in the Tampa Bay area may fare better than most.

The region that includes Florida, south Georgia, Puerto Rico and the 
Virgin Islands has the fifth-lowest narcotic painkiller usage in the 
VA's 21-region system, according to spokeswoman Susan Wentzell.

The C.W. Bill Young VA Medical Center in Pinellas County recently 
started a full-time chiropractic service to help patients manage pain 
without opioids. The James A. Haley VA Medical Center in Tampa runs 
the VA's only inpatient rehab program, which has weaned vets off 
narcotics for 26 years and trains VA outpatient employees around the 
country to do the same.

Opioid-based medicines such as morphine, oxycodone and hydrocodone - 
were originally designed for acute pain from traumatic injury or 
surgery, said psychologist Jennifer Murphy, who runs Haley's rehab program.

Narcotics are not as useful for chronic pain, such as from a damaged 
spinal disc or severe arthritis, Murphy said, because patients in 
time build up tolerance, which can lead to higher doses and then addiction.

'The evidence is mixed, at best, to support chronic opioid therapy," she said.

Yet nationwide, and in the VA, treatment of chronic pain with 
narcotics 'has risen dramatically in the last five to 10 years," Murphy said.

The VA has protocols for monitoring opioid treatment, but the 
inspector general report, released earlier this month, said those 
protocols were frequently ignored.

About half of VA patients suffer from chronic pain, the report said, 
often a product of job related injury. About 15 percent of those 
patients were given narcotic painkillers in 2012, and 5 percent were 
'chronic users," meaning they took painkillers for longer than 90 days.

Among other report findings: VA protocol calls for a urine test 
before a narcotic is first prescribed, plus follow-up visits every 
two to four weeks. Only 6 percent of patients had both the test and follow-up.

About 23 percent of veterans refilled their narcotics prescriptions 
at least seven days early, indicating overuse. About 14 percent 
refilled at least 11 days early.

Random urine tests were recommended every one to six months, but only 
38 percent of vets received the them.

About 13 percent of the patients were current substance abusers. In 
such cases, VA protocols bar narcotics unless patients get substance 
abuse treatment at the same time. Only 31 percent did.

About 7 percent of the vets on narcotic painkillers also received 
benzodiazepines - powerful drugs such as Valium and Xanax prescribed 
for anxiety, insomnia and other conditions that depress the central 
nervous system, making them a dangerous combination with opioids.

In its response to the report, the VA said it had already instituted 
reforms since 2012.

Almost 40,000 fewer vets now receive narcotic painkillers and 80,000 
more are getting drug screenings, the agency said.

At Haley's inpatient rehabilitation program, about 150 veterans 
yearly spend three weeks going through withdrawal and learning to 
manage pain with physical therapy, relaxation, counseling and 
non-narcotic medicine.

Chronic pain disrupts people's lives physically, emotionally and 
socially, said Murphy, the director. Sometimes, just moving hurts so 
much that patients will avoid activity and jeopardize their relationships.

The program also teaches them to pace themselves and move safely. 
'Our goal is to improve function," Murphy said.

In follow-ups held three months, six months and a year after 
discharge, she said, only about 20 percent of patients have returned 
to narcotics.

Lawrence Vass, 55, of Tampa, who completed the program last week, 
crippled his back, legs and knees lifting steel as a combat engineer 
more than 30 years ago.

The pain worsened as he aged despite a regimen of narcotics and 
muscle relaxants. If he took his wife to a movie, Vass said, his 
limit was about 30 minutes before 'I've got to be standing up and 
walking around.' By the time he entered Haley, he bent over as he walked.

'I got tired of living like that, Vass said. 'Very secluded, very 
angry, very distant." Haley has given him a new start, he said.

'I'm not walking around with a grouchy face anymore. I went to the 
park yesterday. It was a beautiful day."
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MAP posted-by: Jay Bergstrom