VA HSR&D researchers conduct an extensive number of investigations designed to improve clinical decision-making and care, inform patients, evaluate changes in the healthcare system, and inform VA policymaking. In Progress is a quarterly publication that highlights new and/or ongoing HSR&D research on various topics.
It is estimated that in 2012, 2.1 million people in the United States suffered from substance use disorder related to prescription opioid pain relievers, and that the number of prescriptions for opioids, such as hydrocodone and oxycodone, have escalated from about 76 million in 1991 to nearly 207 million in 2013.1 Veterans have also been caught up in the opioid crisis, many due to chronic pain. Approximately 60% of those returning from deployments in the Middle East – and 50% of older Veterans suffer from chronic pain, and, until recently, VA was treating their chronic pain almost exclusively with opioid prescriptions. Since 2012, VA has reduced the number of Veterans receiving opioids by 20%, and has cut the overall opioid dosages for approximately 17,000 Veterans. However, the number of Veterans with opioid-use disorders continues to grow, increasing by 55% from 2010 to 2015. Dr. Carolyn Clancy, VA's Deputy Under Secretary for Health for Organizational Excellence, attributes this rise to an increase in diagnoses – a byproduct of improved screening, and cited "substantial progress across the system" in reducing opioid prescriptions and initiatives to better track care for Veterans with SUD.2 These efforts also include rigorous research on opioid therapy.
Improving Opioid Therapy among Veterans with Chronic Pain
This article discusses the Improving Pain-Related Outcomes for Veterans (IMPROVE) QUERI program, which has partnered with clinical leadership to create projects that address cross-cutting issues in pain care, particularly as they relate to opioid therapy.
Identifying Veterans at High Risk of Opioid Overdose
QUERI's Partnered Evidence-based Policy Resource Center (PEPReC), along with a team from HSR&D's Center for Health Equity Research and Promotion (CHERP), will evaluate VA's policy for implementing the Stratification Tool for Opioid Risk Management (STORM) – a predictive model to estimate the risk of opioid-related adverse outcomes among Veterans
Improving Opioid and Benzodiazepine Safety among Veterans with PTSD
Investigators in this study are estimating the annual prevalence of concurrent opioid and benzodiazepine use among Veterans with PTSD, in addition to related serious risks.
Primary Care Intervention to Reduce Prescription Opioid Overdoses
Investigators in this ongoing randomized controlled trial created a brief, tailored intervention to reduce the risk of opioid overdose for patients in the VA primary care-mental health integrated setting.
Safety of Opioid Use among Veterans Receiving Care in Multiple Health Systems
This ongoing study aims to describe patterns of opioid use from VA and non-VA sources among Veterans receiving VA healthcare – and to evaluate the impact of dual use of VA and non-VA opioid medications on patient safety.
Effects of VA Opioid Policy on Prescribing and Patient Outcomes
The main objective of this ongoing HSR&D study is to understand patient-centered outcomes of opioid prescribing changes among Veterans treated with opioids for chronic pain.
A Patient-Centered Intervention to Improve Opioid Safety
Investigators in this ongoing randomized controlled trial are comparing outcomes from two different strategies to improve the safety of opioid medications.