Spotlight: Improving Safety and Effectiveness of Opioid Therapy for Chronic Pain
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 â€“ 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.
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).
The following websites have additional resources on pain management and clinical practice guidelines for opioid prescribing: