VA program reduced prescriptions of 'risky' opioid dosages for veterans

Fewer veterans received prescriptions for opioid dosages deemed risky after a nationwide program to reduce doses of potentially dangerous drugs and drug combinations at Veterans Administration hospitals, according to a press release. The findings are published in Pain.

The Opioid Safety Initiative (OSI), established by the Veterans Health Administration (VA) in 2013, created a dashboard tool that used a national computerized medical record and allowed clinicians at 141 VA hospitals to review opioid prescribing and receive feedback.

According to the release, researchers studied VA opioid doses and compared the year before OSI implementation with the program’s first year. The study focused on patients with daily dosages above 100- and 200-morphine equivalent doses.

Findings showed high-dose opioid prescriptions declined 16% and very high-dose prescriptions declined by 24% during a 2-year period. The number of patients who received both opioids and sedatives declined by 21%, the release noted.

In addition, the OSI program was associated with 331 fewer patients who received prescriptions with daily doses of more than 100 morphine equivalents per month and 164 fewer patients each month who received doses of more than 200 morphine equivalents. In addition, the program resulted in 781 fewer patients who received doses of both an opioid and benzodiazepine.

“As our nation as a whole is learning, it is important to reduce risky opioid-related prescribing,” Lewei Allison Lin, MD, of the University of Michigan Department of Psychiatry and lead author of the study, said in the release. “We hope that these findings, showing the VA OSI was associated with a reduction in risky prescribing, will encourage others to consider similar health care system interventions to address this complex issue.”

However, the release noted that in a minority of VA hospitals, the prescribing of high-dose opioids increased during the study period.

“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,” Mark Ilgen, PhD, of the University of Michigan and senior author of the study, said in the release.

References:

Lin LA, et al. Pain. 2016;doi:10.1097/j.pain.0000000000000837.

www.med.umich.edu/

Disclosures: Bohnert and Ilgen report they are members of the Institute for Healthcare Policy and Innovation. The researchers report funding from the VA Quality Enhancement Research Initiative.