WASHINGTON— Mark Edlund, M.D., Ph.D., health services researcher at RTI International, told members of the U.S. Senate Committee on Veterans’ Affairs that substance abuse patients at the Veterans Health Administration were less likely to be heavy users of opioids than similar patients in other health care systems.
At the hearing on Overmedication: Problems and Solutions, Edlund provided initial findings of RTI’s research that examined and compared the prescription use of opioids in patients in the Veterans Health Administration (VHA) to other health care systems, particularly among Operation Enduring Freedom and Operation Iraqi Freedom veterans.
“The opioid use of Operation Enduring Freedom and Operation Iraqi Freedom VHA patients has been the subject of scrutiny,” Edlund said. “We found that among VHA patients with chronic non-cancer pain, Operation Enduring Freedom and Operation Iraqi Freedom patients were less likely to be prescribed opioids as other VHA patients, and among VHA patients with chronic pain who were prescribed opioids, only about 40 percent were as likely to be heavy utilizers of opioids.”
Edlund reported on key aspects of prescription opioid in the VHA, including the rates of prescribing opioids for VHA patients with chronic non-cancer pain; factors associated with discontinuing chronic opioid therapy; and factors associated with heavy opioid use among VHA patients.
The research, funded by the National Institute on Drug Abuse, showed that the percentage of VHA patients with chronic pain who receive higher doses of opioids is relatively small and lower than those in other health care systems. The amount of days in which chronic pain patients receive opioids is typically higher within the VHA; however, the median dose of opioids is lower than other health care systems, according to Edlund.
“While high daily dose is not common among VHA patients, both high daily dose and use of long-acting opioids were strong predictors of opioid continuation,” Edlund said. “Individuals with substance abuse disorders and mental health disorders were more likely to discontinue opioid use. This is important, because these patients are at an increased risk of opioid abuse.”
Edlund also said that the rate of discontinuation among VHA patients was consistent with those of other health care plans for patients who received at least 90 days of opioids within a 180-day period. Research found that nearly 80 percent of these VHA patients who received at least 90 days of opioids will have years of opioid therapy.
Edlund reported that the VHA, overall, screens out substance abuse patients from high use of opioids better than other health care systems.