Veterans Opioid Prescription Initiative Successful

The Opioid Safety Initiative reduced high- and very-high dose opioid prescriptions among veterans.

A new effort was able to decrease the number of US military veterans receiving risky opioid prescriptions, according to a study published by Pain. This initiative reduced high doses and potentially harmful drug combinations that were prescribed to veterans, and may have the potential to do so in other large health systems.

Over the 2-year study period, high-dose opioid prescriptions decreased 16%, and very-high-dose prescriptions decreased 24%. Additionally, the investigators found that patients receiving prescriptions for opioids and sedatives, a potentially lethal combination, decreased 21%.

In the study, the researchers observed the effects of the Opioid Safety Initiative (OSI) created by the Veterans Health Administration (VHA), which was implemented in all of the Veterans Affairs (VA) hospitals. During this program, the VHA developed a dashboard tool that allows VA leaders to review opioid prescribing through electronic health records (EHRs), and provide feedback.

The investigators evaluated opioid prescriptions 1 year before and 1 year after the program was initiated. The VA was previously unsuccessful in lowering opioid prescriptions, but these findings show that the OSI led to significant decreases, according to the study.

The potency of opioids can be measured in morphine equivalents (MEQs). The researchers studied those with prescriptions above 100 MEQ and 200 MEQ.

The investigators found that after the OSI was implemented, 331 fewer patients per month received opioid prescriptions with daily doses of 100 MEQ or above, and 164 fewer with daily doses of 200 MEQ or above, according to the study.

Accidental overdoses resulting from a drug interaction are also on the rise. Due to the OSI, 781 fewer patients per month received prescriptions for opioids and the sedative benzodiazepine.

Although a majority of hospitals saw a significant decrease, a small amount of hospitals had an increase in high-dose opioid prescribing, according to the study.

However, despite the positive findings, the study authors caution physicians and policymakers that a patient’s pain, mental health, addiction care needs, and physicians’ decision making needs to be taken into account when determining if the prescription is necessary, according to the study.

"As our nation as a whole is learning, it's important to reduce risky opioid-related prescribing," said study first author Lewei Allison Lin, MD. "We hope that these findings, showing the VA OSI was associated with a reduction in risky prescribing, will encourage others to consider similar healthcare system interventions to address this complex issue."

Opioid misuse disorder and associated overdoses are increasing, and so are initiatives to drive down these statistics. While these programs are moderately successful, many Americans still develop the disorder. A focus on preventing unnecessary opioid prescriptions has been the recent answer to this problem.

This audit and feedback approach has also been used in other ways to successfully improve healthcare. Creating a single computerized EHR system allows VA leaders to see how opioids were being prescribed, and to compare this data to national and regional data, according to the study.

The study authors believe that other large health providers may choose to use their EHRs in this way, and implement similar programs to combat the opioid epidemic.

"These results highlight the importance of addressing provider behaviors in our efforts to address the opioid epidemic, and the need for large health systems to develop and implement systematic approaches that are flexible enough to allow clinicians to make individual decisions while still reducing the overall prevalence of potentially risky prescribing,” concluded senior author Mark Ilgen, PhD.