EDITORIAL: VA doctors must reduce painkiller prescriptions

December 8, 2013 

Too many doctors at VA hospitals are taking the easy way out by overprescribing painkillers to wounded veterans.

SUE OGROCKI — AP

Straining under the surge of post-9/11 veterans, VA hospitals have added reinforcements and expanded access to care. But it appears that too many doctors and administrators are seeking an easy way out by overprescribing painkillers, endangering the health of people wounded in war.

In another important report, Aaron Glantz of the Center for Investigative Reporting has revealed that U.S. Department of Veterans Affairs prescriptions for four highly addictive narcotics — hydrocodone, methadone, morphine and oxycodone — jumped by 270% between 2001 and 2012, far exceeding the rise in the number of patients.

While prescription drug abuse is a problem in the civilian world as well, the VA's own researchers found that the fatal overdose rate was nearly double the national average. They also found that doctors were prescribing more opiates to veterans with post-traumatic stress and depression, even though they are the most at risk of overdose and suicide. Glantz opened his piece with the chilling account of Jeffrey Waggoner, a former paratrooper trying to kick his addiction to painkillers who was inexplicably released by the VA hospital in Roseburg, Ore., with more opiates. Within hours, he died of an overdose in a motel.

Last week, Glantz followed up his September investigation with a report that physicians at the San Francisco VA Medical Center routinely renewed prescriptions for painkillers without seeing the patients. Investigating a tip to its hotline, the VA's inspector general also concluded last month that doctors did not consistently monitor patients for painkiller abuse. The IG documented seven opiate overdoses, including three suicide attempts.

The VA says the medical center is resolving the issues raised by the inspector general. The department, however, still faces the broader problem that persists despite regulations, issued in 2009, that instruct doctors to focus more on treating the root causes of pain, rather than using narcotics to treat symptoms. As Glantz reports, at a congressional hearing in October, some VA doctors said they were pressured by administrators to prescribe painkillers to patients they had not examined.

This is a big issue for California, which has the most veterans of any state — 2.2 million — with their ranks growing by an estimated 30,000 a year.

In a statement to The Sacramento Bee's editorial board, the VA said Wednesday that it "takes seriously the responsibility to balance the need of veterans with pain and the potential dangers of prescription medications, including opioids."

The VA said that some of its 21 health care networks have taken steps to reduce the use of opiates. The one based in Minneapolis has cut use of high-dose painkillers by 50% and all but eliminated Oxycontin prescriptions. The VA also said it is offering and encouraging alternative therapies, treatments and programs to manage chronic pain, and raising awareness of the risks with pamphlets and "pain schools" to educate patients and their families.

All those approaches sound good. But it's clear that the VA needs to do more to make sure they are put into practice at all of its medical centers and clinics. Injured service members should not survive combat in Afghanistan or Iraq only to succumb to prescription drug addiction once they're supposedly safe at home.

 

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