Opioids Overdose Massachusetts

VA Study Suggests Non-VA Care Linked To Higher Opioid Risks

A VA study evaluating veterans in Massachusetts suggests veterans receiving opioids from both VA and non-VA doctors are at higher risk for adverse events than those who receive only VA care.

VA’s study sample included 16,866 veterans residing in Massachusetts. Of those, 9238 (54.8%) veterans received controlled substances from VHA pharmacies only and 7628 (45.2%) had filled prescriptions at both VHA and non-VHA pharmacies. These were called “dual care users” in the study that evaluated care between October 1, 2013, and December 31, 2015. The primary outcomes were nonfatal opioid overdose, fatal opioid overdose, and all-cause mortality.

On its face, I can see this study being extrapolated in some media outlets to lead readers to believe VHA care is superior to non-VA care. It is curious that the agency only published the results of one study in one state instead of numerous findings across many states.

VA Explanation

VA explains the outcome as follows:

Twenty-six percent of dual care patients in the study received high-dose opioid therapy. In contrast, only 7 percent of VA-only patients received high-dose opioids. While only 8 percent of VA-only patients had prescriptions for both opioids and benzodiazepines, 35 percent of dual care patients were prescribed both drugs. Benzodiazepines are drugs commonly prescribed to treat anxiety, insomnia, and alcohol withdrawal. Taken together, opioids and benzodiazepines have a tenfold higher risk of overdose than opioids alone. Furthermore, 7 percent of dual use patients received a diagnosis of opioid use disorder, compared with 2 percent of VA-only patients.

The researchers also found that dual-use patients had worse health outcomes. These patients had higher odds of having a non-fatal opioid overdose than VA-only patients. The study did not show higher odds of fatal opioid overdoses. Despite this finding, the dual use group had higher mortality from any cause than the VA-only group. More than 9 percent of dual-use patients died during the study period, compared with only 4 percent of VA-only patients.

The results highlight the importance of using prescription monitoring programs to reduce fractured care between multiple health care providers, according to the researchers. Dual care use “is leading to greater likelihood of uncoordinated care among Veterans across the United States,” they write.

VA’s Opioid Safety Initiative requires VA doctors to share data on controlled substance prescribing with state prescription monitoring programs. VA also uses pain management teams to coordinate and oversee pain management therapy. These teams check state prescription monitoring programs at least annually to look for co-prescribing of opioids. The findings show the need to continue to share data between VA and other systems in this way, say the researchers.

Caution Against Extrapolation

The agency concluded its summary of the study by cautioning against applying the results of this study across the general population of the country:

The researchers caution that the results cannot be applied to the country’s general population. While the data from Massachusetts suggest a need for more coordination between different health care systems, the researchers point out that different communities have different cultures and structures that could influence how these relationships work.

Nevertheless, the researchers suggest several further steps to cut down on dangerous co-prescribing of opioids to patients using more than one health care system. More education on safe opioid prescribing procedures are needed, both within and outside VA, they say. They suggest the aggressive dispensing of naloxone—a medication that blocks the effects of opioids, which can reverse the effects of an overdose if given correctly—to Veterans taking opioids, and to their families. The researchers recommend that dual care users be provided more resources and closer care coordination, such as pharmacy education and case management, to make sure their opioid use is safe. Finally, they recommend implementing prescription drug disposal to help patients get rid of unused medications.

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  1. TOMAH again…. refuses to prescribe any opioids to just the female veterans. It forces me to have to pay for private medical care and pain meds out of my pocket for my service connected disabilities. Just yesterday an employee at Tomah told me that they know exactly which doctor refuses to treat pain for female veterans service connected disabilities.

    I don’t really understand why then when veterans are constantly targeted regarding opioids. Veterans often face obstacles like I’m dealing with via Tomah. But also private care providers have heard so many negative things about veterans and opioids that it’s even hard to receive pain management in the real world. At least for me it is.

    I have really begun to wish I’d taken a different career path. I can’t tell you how many times providers have verbally lambasted me because my VA won’t prescribe female veterans a single pain pill. What makes me any different than a person who was hurt in a civilian job?

    I was crushed in an accident in an aircraft in Korea during Team Spirit. I also was hurt a number of times over the years loaing cargo on aircraft in the Air Force. Plain and simple the VA doesn’t care I live with such excruciating pain from those injuries. They’d rather accuse me of it being in my head…. which my VA doctor’s nurse did by leaving a message on my home phone saying my pain was psychosomatic…. after an MRI they did showed extensive damage to my spine. They’re nothing but a deer in headlights when I try to talk to them about it.

    So I’ve paid thousands upon thousands of dollars for private medical care of my service connected accident pain. Overall my back is rated 60 percent between the thoracic and lumbar damage. Overall I’m rated 100 percent service connected.

    I really don’t get then why the VA is making an ordeal about veterans who get pain meds from private providers. Like me, most of them were probably forced to go to private providers for treatment of pain.

    1. Suggest you sign up for this research:
      DAV calls for more research into medical cannabis as an alternative pain relief option for veterans with chronic pain, PTSD and TBIs.
      See the DAV Newletter.

      I’d write a letter to the nearest VA Regional Medical and Research Center copying it to the VA Central Office and NIH including your complaing about the physician by name.

    2. A link to “Learn More” from the DAV Newsletter:
      “https://www.dav.org/learn-more/news/2018/the-cannabis-cure/?utm_source=email&utm_medium=email&utm_campaign=DecENL&s_src=2018decemberenl&s_subsrc=member” Copy it in and remove the before and after “

    3. Be sure to add a concern of becoming addicted to opiates and your physician’s obvious fear of opiate addiction causing disabling pain. Put in for compensation for “pain.” It is a new disabling condition recognized by a CAFC decision overturning the BVA and CAVC in a Presidential finding by the second highest court. The VA will treat rather than compensate.

  2. As a Veteran who has chronic pain for service-connected combat injuries (yes, one really has to be THAT specific with the VA), I receive NO PAIN MANAGEMENT from the Central Texas VA—specifically, no Pain Management Specialists are available to my Primary Care Team (PACT) at the Austin VA Outpatient Clinic. Nerve Blocks are available at the clinic in Temple, 91 VA miles away (101 actual driving miles). No Pain meds.

    I receive Clonazepam 0.5mg for Myoclonus for a service-connected combat gunshot wound to the left upper extremity (just below the collar bone). I receive no Pain Meds. The Officially Stated US Dept. of Veteran’s Affairs is that “opiods may only be prescribed for pallative care of cancer patients”. Full Stop.

    Or at least, that’s the fig leaf the Drs. at VAOPC Austin deploy.

    Therefore, I must pay for my Pain Management care out of my pocket (and my wife’s insurance)—including the cost of the Rx. I receive 120mg MED (Morphine Equivalent Dosage)—part of the widespread discrimination applied to patients suffering chronic Pain. Narcotic Analgesics are treated as a DAILY dose, even though they, like all other drugs, are titrated (sp) based on their half-life. What I really take is one 30mg Sustained Release Morphine tablet every 8 Hours, and one 2mg Dilaudid every six hours if needed for breakthrough pain. Nothing like 120mg. But 120mg sounds much worse.

    The point here, though, is that it is the VA’s own doing that I am subject to “dual-care”, because if I were to submit to “single-care”, I wouldn’t get any.

    The VA, of all places, should have capable, qualified,Pain Management Specialists who are not biased against ANY treatment protocol for Veterans suffering chronic pain, and who are specifically qualified to deal with the chronic pain that comes from catastrophic combat inuries (like IEDs, gunshot wounds, schrapnel, burns, etc…). Until that is a VA-Wide Requirement, so-called Dual-Care is the ONLY care available to Veterans.

    I am sick to death of hearing “my license” as a reason the VA Drs. will not prescribe an Rx my civilian Pain Management Specialist is willing to certify and to provide full records for. I rather fell that “their license” is what OBLIGATES them to treat me, as does their JOB at the Veteran’s Administration.

  3. VA over-prescribing opiates for years? No problem, “We’ll just cut all the Vets off!” We were over- prescribing too many Benzo’s too? No problem. “We’ll quit giving the Vets them too! We have literally hundreds of pills that used to be used for a certain condition, but is now found to be helpful for a multitude of other conditions according to our studies!” “Here, take this pill- ‘it takes six months to work’ (wink wink)- see ya in six months.” Not working? “Here try this epilepsy pill, we found it helps with depression too, also takes six months to ‘work’.” Repeat over and over. “But we’ll give you all the Ibuprofen, Tramadol and Gabapatin you want! Don’t forget, Gabapatin takes three months to work too.” They’ll eventually find a pill that takes a year to ‘work’ to keep you out of their hair….

  4. Extrapolated. Every study the VA does is biased. The VA don’t give a fuck about veterans in pain (mental or physical), the number of veteran suicides per day should verify that. This is just a VA cover their own ass report. The VA’s war on drugs, has always been a war on people, just an excuse for the VA to do nothing or as close to nothing as possible. Federal drug scheduling has been fubar ever since it was created, when it comes to drugs {pharmaceuticals) why would, and why should anyone believe anything the VA says. How many of the drugs in the VA formulary come from substandard facilitys in China and India? That’s a report the VA should be doing but will not, why, because VA management and congress don’t give a shit.


  5. Soooo If I understand correctly – The VA’s problem areas are:

    1) Outdated computer system which has been emptying money into tech companies pockets without them updating the system but rather they take the money and run. (While veteran’s are being cheated)
    2) Mediocre staff of national rejects in the medical profession, in management and other related positions. Then as a result of the hiring issue, these rejects caseload are so high that they are incompetent and incapable of providing adequate care. (Almost killed me with this one)
    3) The VA’s management of the Choice program is riddled with discrepancies where some veteran’s can utilize the option and other’s are denied. (First hand experience with this one)
    4) VBA is better at passing the buck rather than awarding claim appropriate benefits. In addition, the veteran whose claim has been denied should be given a reason as to why and assistance in remedying the issue, if possible. (I know what I’m talking about)
    5) The VSO are cronies, and in my experience, worthless. (Bad experience with these misogynist …)
    4) There isn’t a non-VA resource to handle these grievances therefore the problems are rarely, if ever, resolved with any of the above mentioned issues. (Please, please make this happen)

    And the beat goes on. OOoooh those dastardly Ivy League cronies and their sycophants what are we gonna do?

    God Speed

  6. The VA is crazy, while some are very good doctors taking advantage of 40hr work weeks, no malpractice insurance and benefits with pensions, too many get sucked up by negative energy. For a pcp it’s like the best job ever in some hospitals doing nothing and their nurses do less than that. The VA opioids policy is killing people taking away meds and told ibuprofen. They will also will put on methadone or try depression medication moving into a different category. They weren’t counting people using Choice, don’t know if changed but brought numbers lower. You can’t impose umbrella treatment or make someone live in pain because of a percentage. I wish chose a different path and never used the VA, worst part is people who have worked a long time and know all the ins and outs to use to do nothing. Realize each hospital is different, but I have seen doctors with more anger than the patients.

  7. I am retired Marine Corps – hence TriCare for Life (2ndary) with Medicare primary.
    Every prescription filled gets entered into the system, no matter where it is filled.
    It does not matter whether prescriptions are filled at Madigan Army Hospital, Rite Aid, Costco, etc.
    Everybody can see everything – much to my chagrin if I am trying to get something refilled too soon.
    Would not this be the best and first place any studies should start looking?

    1. I was told by 3 different VA DR.’s that the best way to get ALL of your meds
      was to call in as soon as you got them. Now this backfired me on a workman’s comp.
      My lawyer wasn’t to quick on the VA rules & when the prosecutor pointed out all the
      quick calls to get my 5mg hydrocodine. My Lawyer didn’t say a word but the prosecutor
      cut me to pieces on the stand making me look like a full blown junky. I could see the judges
      faces. They were listening to every time I called in early on Hydro’s. I know I had a suck lawyer
      but hey. The VA told me to do this but denied anyway

  8. More VA Lies and Bullsh*t. The VA Medical Director here in San Antonio cut my pain meds in half after being on the same dose for 6 years without checking my medical records and as to why I was being prescribed them. I went through terrible withdrawals and was desperate for relief. More than once I wanted to kill myself to escape the unbearable pain. I was one of the fortunate ones to find a great Pain Management Doctor outside the VA. Not only did he put me back at the original VA Dose, but increased it because they were under prescribing pain meds to me.

    This is why most Veterans were getting prescriptions from outside the system. They were also under prescribed/cut back without any warning by the VA. No doubt many took their own lives after not being able to find an outside doctor to prescribed them the minimum pain meds they needed to make it through each day.

    Now you have the CDC and their bogus 6 week study lying that long term pain med dosing does not work. Mine has worked for 6 years! The study was conducted by doctor’s who are anti-opiates. So EVERYONE has their pain med dose cut in half regardless what you are suffering… such as terminal Cancer, failed back and or neck surgery, etc. EVERYONE is different in what dosage they need for their pain. Throw in the DEA Henchmen to go after legit Pain Management Doctors and patients who have completed every appointment, every required drug test, never abuse their prescriptions. They have threatened every doctor with taking their licenses leaving the doctors zero way to fight for a higher dose for their patients. Pain Patient suicides have increased greatly. The DEA and CDC only care about Street Drug Addicts repeatedly over dosing sometimes 4-5 times a week and whom only care about their next high. The DEA and CDC have the blood of innocent pain patients killing themselves on their hands because these clown have take away their only option for pain relief. Insane….

  9. I no longer believe any studies originating and being funded by government agencies.
    Then you have the vets that ask for pain meds and get non. They become the 25+- suicides per day because they no longer want to deal with pain. When the VA started to hire affirmative action candidates with IQ’s below 80 things began to deteriorate in that organization and the cost went up

  10. Meanwhile, we were supposed to get a cola raise this month. Naturally I didn’t get it and i don’t fucking care because it was a whole $25.

    Suck me off VA and then go see the hangman for some stiff neck treatment ya cocksuckers.

  11. If the corrupt VA would only provide FULL TIME Acupuncture care , as much as any Veteran needed for pain . I have received it in a series of 8 ? , how many times ? I have to wait at least a year before another series , why ? This is for a degenerative vertebrae in my neck . It gets rid of the pain and stiffness and even months later after the last session . As of course it should be provided as to the best benefit for any Veteran . As in frequency and so be it , forever to keep the pain in remission . As we know the corrupt ” western medicines ” , solution is narcotics . That will by nature cause additional problems in so many other ways . Unfortunately they used regular office chairs for us to sit in . Rather than a comfortable reclining chair as they use in IV Therapy . This is through the Seattle VA Hospital , they also have it at American Lake VA Hospital in Lakewood , WA .

  12. I’ll be Damn,
    You mean V.A. Figured out if a person gets opiates from two different places then it is worse than getting it from one.

    WoW, I think they are getting smarter.

  13. Propaganda by VA for not wanting to admit their part in the Opiate/Opioid Epidemic.

    VA trying to look good by improving their image by these substandard methods to obtain the results that the VA needs and wants.

    Why should anyone trust the VA in tbe first place, when the VA played a major role in creating the epidemic in the first pksce.

    Give me a break. VA still shoveling and piling up the bullshit.

    Since being on Bens site, I’ve iften wondered who the VA thinjs they are talking too.

    Like always this us an insult of underminding what most Vets already know and believe.This isn’t a good run for their money. 4Realz.

  14. IMHO, this “study”, which has too many flaws, is nothing more than a way to keep veterans in the “VHA Healthcare Deathtrap”!
    Dr. Kavorkian and VHA are two of a kind!


  15. “Twenty-six percent of dual care patients in the study received high-dose opioid therapy.”
    Thats because real doctors after reviewing your records in full understand that your in Pain
    Unlike the VA docs that only look at the latest Radiology report that say nothing more than arthritis, Because VA radiology never repeats what they have already reported and the VA doctors never look at the ones before, that say herniated Discs So I am going to bring my copy of the MRI next time and ask him if he cured me by sitting in his office a couple of times a year, Most of them are Rejects of the medical field ..LOL

    Here’s A good example of how VAMC Gets their top notch doctors, They find the desperate ones no one else will hire……And most of the good ones I encounter are gone in less than a year

    Bielefeldt has left UPMC and is now working at a Department of Veterans Affairs hospital in Salt Lake City.????

    1. I know what you mean. I have been through 5 different VA doctors (4 if you count the original PA) in less then 8 years. I wonder how long this one is going to stay since he has already had two heart attacks and had a couple stints put in. I give this one less then 2 years before the stress they claim makes him retire as well. Then I got to wait probably another year before I get a Doctor assigned to me. Thats how long it took for them to assign me this one. Yesterday was the fist time in over 18 months that I actually saw a VA Doctor and you are supposed to see one every six months.

      1. Dan, I can confirm & corroborate your post 100%, as I am in the ‘waiting to be assigned ‘ a new doctor mode. It seems the one I had, from Dec. 2017 to Dec. 2018, was active duty reserve and has just been redeployed to Afghanistan. I asked him, upon my last visit, who I would be seeing as PCP after his departure. His reply? “I have no idea.”

        Since that time, I have gone full-circle through the finite cast of characters who populate the Staff at the Missoula V.A. Clinic. A complete wild goose chase. One directs me to the other, and back again. Bottomline, they do not have sufficient Staffing, and have no idea who I will be directed to see. In the meantime, despite facing an urgent/critical health crisis at this time, the best they can provide is a phone conversation with some long-ago retired Nurse who found a second-lease on life working for the V.A. Needless to say, she is woefully unqualified to lend me the medical expertise I need at this time.
        Meanwhile, these buffoons keep putting hundreds of millions of dollars into relentlessly ‘improving’ their technology systems, and assail us veterans with the transparent marketing of their bullshit lies.

  16. Rise and Shine Veterans email your Senators or Representative contract raiise the Veterans Health Budget because their is lot of Medical Centers, Medical Doctos, Medical Clinics won’t accept 100 percent service connected Veterans.

  17. “Candyman”….Tomah, VAMC Overprescribing Scandal where Houlihan?…Concocted his own little OFF-LABLE JUICES to keep Vets just coming back crying for more and dying….yeah, THAT ***SAFE** VA?

    HAHAHAHAHA…helped me push another out into the suggestion tubing network this morning….even cat is laughing……hahahahah….meow!!!!!!!!!!!!

  18. VA attempt at PSYOPS at it’s very worse in order to garner more nonhuman test subjects the way of the VA instead of much safer options when we know the VA in-part FUELED the opiate crisis in OVER FUCKING PRESCRIBING you assholes!!

    “Repeat a lie enough times, people will believe the lie”– Hitler and many more hits of narcissists of earth.

  19. IMO, this is another one of those staff written topics, that has been provided to see just how agitated Ben’s readers will become during posting times. This is ‘old hat’ news being recycled by nih and VHA. Wasn’t it 2016ish when Sen. Tammy Baldwin got it mandated (paraphrasing) that any veteran with any mental health issue (or as one veteran has pointed out on here, an anti-d/anxiety script for off script reasons) won’t be allowed pain relief through primary care? There have been many posts in the past couple of years on this topic; so, (tic) I guess VA/VBA/VHA and VocRehab is all fixed now and there are no fresh topics to explore.

    This is the 11/24/2018 abstract “https://www.ncbi.nlm.nih.gov/pubmed/30452210” on which Tristan Horrom, VA Research Communications based his 12/04/2018 article “https://www.research.va.gov/currents/1218-Higher-overdose-risk-seen-in-Massachusetts-patients-getting-opioids-from-both-VA-and-non-VA-pharmacies.cfm” which is the study link for today’s topic.

    1. Well written Rosie!
      Gotta feeling VA is trying to rehash, (through their well paid [$25 million/yr] public relations firm) a false narrative between civilian and VHA healthcare!

    1. I believe nothing coming out of Mass,,,that is Andrew Kolodny territory of propaganda against the MEDICINE ,THUS THE RICHER HE GETS ON THE ADDICTION INDUSTRY SIDE.800 % INCREASE to his addiction warehouses,,,w/his phony addiction data..Never In our history has legal medicine been combine w/street drugs,ie heroin to TRUMP up numbers as America has done now a days.Its all about $$$$,,,they don’t want to pay for pain management,,plain and simple,,sooo they put out all this propaganda ,”reefer madness,” crap,,,Never mind truth,,that suicide have skyrocketed since torture of the medically ill in physical pain is being perpetrated thru-out our lands. Being denied access to effective dosages of MEDICINE to EFFECTIVELY lessen physical pain,,IS Thee definition of torture btw,,maryw

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