Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

Spotlight: Improving Safety and Effectiveness of Opioid Therapy for Chronic Pain

October 2013


In the United States, pain is the most common complaint that leads patients to seek medical care. More than 50% of male Veterans using VA primary care report chronic pain, and the prevalence may be higher among female Veterans. Pain also is the most frequent presenting complaint of returning OEF/OIF soldiers seeking VA healthcare (>50%), and is particularly prevalent among those with polytrauma (>90%).1 Thus, the safe and effective use of opioid therapy for chronic pain is a significant healthcare priority. Moreover, patients with substance use disorders (SUDs) or a history of SUDs are more likely to experience chronic pain compared to non-substance using patients, and if they receive opioids, they are more likely to misuse their medication and even develop or relapse to opioid dependence or addiction. Therefore, patients with SUDs or a history of SUDs need to receive opioids and pain management services in ways that optimize their safety and effectiveness.

VA/HSR&D's Substance Use Disorder Quality Enhancement Research Initiative (SUD-QUERI) was instrumental in the development of the Opioid Therapy Guideline Adherence Report–a set of national metrics to assess gaps in guideline-recommended opioid therapy practices, as well as variations in facility-level performance.2 SUD-QUERI also has funded a subsequent project to study how patient, facility, and medication characteristics are associated with serious adverse health events and the receipt of guideline-recommended opioid therapy practices by Veterans with substance use disorders.

The Opioid Therapy Guideline Adherence Report consists of 12 key practice recommendations from the VA/DoD "Clinical Practice Guideline for Opioid Therapy for Chronic Pain,1" and operationalizes these recommendations by using data from VA's electronic medical record. In addition, the Report provides information about a facility's rate of serious adverse health events for patients prescribed opioid medications. The practices tracked in the report have been directly linked to these serious adverse health events (e.g. co-prescriptions of opioids and sedatives). Examples of metrics include:

  • Providing appropriate follow-up for new prescriptions,
  • Avoiding sole reliance on opioid therapy, and
  • Performing urine drug screening.

The Report is available via the VHA Support Services Center ( VSSC), and can be used to help track facility-level prescribing practices, as well as the impact of programs such as the Opioid Safety Initiative (sponsored by theVHA Pain Management Program Office), and the ATHENA-Opioid Therapy DSS – an automated decision support system developed in collaboration between Stanford University and VA/HSR&D to facilitate physicians engaging in guideline-adherent prescribing of opioid therapy for chronic pain.

The Opioid Therapy Guideline Adherence Report is available at the VSSC website in the "user acceptance testing" section (a menu option at the top right hand side) under Mental Health.

For more information about the Report, or the underlying database of VA patients who are prescribed opioids, please contact Jodie A. Trafton, Ph.D., at Jodie.Trafton@va.gov , Director of the Program Evaluation Resource Center (PERC) an evaluation center within VA Mental Health Operations, or Eleanor T. Lewis, Ph.D., Eleanor.Lewis@va.gov , health science specialist in PERC and at the VA Center for Innovation to Implementation (Ci2i).

References

1. VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain. Department of Veterans Affairs, Department of Defense; The Management of Opioid Therapy for Chronic Pain Working Group. 2010.

2. Midboe A, Lewis E, Paik M, Gallagher R, Rosenberg J, Goodman F, Kerns R, Becker W, Trafton J. Translational Behavioral Medicine 2012. 2(1): 57-64.

Additional Resources

The following websites have additional resources on pain management and clinical practice guidelines for opioid prescribing: