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Veterans’ health-care gap creates ‘greater risk’ for opioid abuse

The veteran is identified as “Patient 1.”  He was “hospitalized twice for suicidal ideation and a reported suicide attempt.” But only later, in a case of a buried lead, does the report say another attempt was successful — “suicide caused by toxic levels of sertraline, morphine, and gabapentin.”

This veteran — one of 20 who kill themselves every day, a frightening figure — received medical care from the Department of Veterans Affairs (VA) and a non-VA doctor who prescribed opioids for his chronic pain.

While psychological factors were the reasons and drugs were the tools, the suicide was facilitated by a hole in a system designed to give vets the choice, in same cases, to obtain outside medical care at government expense. With Patient 1, “there is no evidence in the medical record that any of his VA providers were aware of the new opioid prescriptions,” according to the inspector general.

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That gap in coordination, added to differing clinical standards among VA and non-VA community providers, can be deadly. Health professionals outside VA are not required to follow departmental guidelines.

Veterans receiving opioid prescriptions from private clinics “may be at greater risk for overdose and other harm because medication information is not being consistently shared,” Inspector General Michael J. Missal said when the report was released Tuesday. “That has to change. Health-care providers serving veterans should be following consistent guidelines for prescribing opioids and sharing information that ensures quality care for high-risk veterans.”

His office recommended that VA:

  • “Require non-VA providers to submit opioid prescriptions directly to a VA pharmacy for dispensing.”
  • Ensure those providers have “a complete up-to-date list of medications and medical history.”
  • Require community providers to review VA opioid guidelines.
  • Ensure that if community facilities don’t meet VA opioid standards that “immediate action is taken to ensure the safety of all veterans receiving care from the non-VA provider.”

VA agreed, at least in principle, with all the recommendations.

“With America facing a looming doctor shortage and demand for veterans health care outpacing VA’s ability to provide it in-house, better coordination between VA and non-VA providers is absolutely essential,” said VA press secretary Curt Cashour.

Committee to Elect Byron Bradford
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