The President declared war on the Nation’s opioid epidemic last week. “This epidemic is a national health emergency,” he said. “Nobody has seen anything like what is going on now,” except, that the VA has been on the front lines of this battle for a couple months now.
In February of this year, the Department of Veterans Affairs published a clinical guideline for the use of opioids when treating chronic and acute pain. On the VA’s website, you can read information that’s directed towards patients as well as a very clear playbook for medical providers regarding the use of opioids.
Opioids can be either natural or manmade chemicals and work by changing the way your brain senses pain. In part, this is done by controlling emotion which can help weaken the effects of painful stimuli. Prescriptions for Vicodin, Percocet or OxyContin have been in use for years, but recently, medical science has found new information about the drugs. The new information shows that opioids are not as safe or as effective as once thought.
The VA’s guidelines on when to prescribe opioids is boiled down to a very clear summary of recommendations. for example, OT for chronic pain shouldn’t last for more than 90 days. The recommended dosage is the lowest dose indicated, “as there is no safe dose and risk increases with dose.” So, in other words, according to the VA, there is NO safe dose of opioids.
If your medical team decides that you should continue with OT, there will be ongoing risk justifications on the side of the VA. These may include random urinalysis, checking state prescription drug monitoring programs, monitoring for overdose potential and suicidal thoughts. The VA will provide overdose education and possibly a prescription of naloxone rescue and the education you’ll need to use this drug. VA’s evaluation of patient risks takes place every three months and more frequently if the dose increases.
For veterans suffering acute pain, the process is similar. The initial prescription is for only three to five days, with the lowest dosage to start. After the initial period, a reassessment is done and the medication is either adjusted or stopped completely.
Another big part of OT is the informed consent discussion. This part of the process focuses on the patient, including why the patient is there and their personal goals for opioid treatment. The patient is then given all the known risks, side effects and benefits of opioid treatment. Alternatives to OT must also be discussed. The patient then must acknowledge that they understand the importance of a variety of strategies all focused on minimizing the bad side effects of OT for the patient and others involved.
Right now, all alternative to OT that seems to get the majority of press is medical marijuana. With marijuana still considered a Schedule I drug, the VA can’t conduct research on of cannabis. Other, non-invasive alternatives to OT include acupuncture, chiropractic care or physical therapy. Some people say these are just as effective, sometimes more effective, than medications. Plus they are safe and there are no side effects.