Opioid prescribing at veterans hospitals varies widely in treating chronic pain

AURORA, Colo. (April 24, 2018) - A new study of treatment options for military veterans with chronic pain has determined that care practices at Veterans Health Administration (VHA) facilities vary widely and could contribute to a veteran's likelihood of using opioids.

A recently published article in the Journal of General Internal Medicine surveyed care provided to 1.1 million veterans at 176 VHA medical centers between 2010 and 2015. At some centers, as many as one-third of the veterans seeking care for chronic pain began long-term opioid therapy, compared with only 5 percent at other centers.

"We found that there were not consistent practices between VHA facilities," said senior author Joseph Frank, MD, MPH. "While there is a consensus that multiple approaches to care are important, there is a wide variation in availability of those options at some centers."

Frank, who is an assistant professor of medicine at the CU School of Medicine and an investigator for the VA Eastern Colorado Health Care System's Center of Innovation for Veteran-Centered and Value Driven Care, and his fellow investigators reviewed 10 pain-related treatment options, including physical and occupational therapy, and non-opioid pain-relief medications.

They found that when a facility had a wider range of treatment options to provide, veterans were less likely to begin long-term opioid therapy. They also found that sites that offered more non-opioid medications ultimately had higher rates opioid use by veterans.

The results of the study are important because of efforts to reduce the use of opioids due to the rising numbers of addiction and overdoses of the drugs. In 2017, the U.S. Departments of Veterans Affairs and Defense issued guidelines on opioid therapy for chronic pain that strongly recommend non-pharmacologic treatments and non-opioid medications.

"This study is a first step in understanding the institutional cultures that may contribute to the use of opioids to treat chronic pain," said Frank. "We need to continue our work to understand better ways to provide non-opioid treatments across diverse, real-world clinical settings. We'll need the help of healthcare leaders and investments by healthcare systems to gather evidence on non-medication treatments. We'll measure success in quality of life and in prevention of opioid-related harms."

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The study was supported by the U.S. Department of Veterans Affairs, Quality Enhancement Research Initiative. In addition to Frank, other authors of the article are Evan Carey, MS, and Charlotte Nolan, MPA, of the VA Eastern Colorado Health Care System; Robert Kerns, PhD, of the VA Connecticut Health Care System and Yale University; and P. Michael Ho, PhD, of the University of Colorado School of Medicine and the VA Eastern Colorado Health Care System.

Faculty at the University of Colorado School of Medicine work to advance science and improve care. These faculty members include physicians, educators and scientists at UCHealth's University of Colorado Hospital, Children's Hospital Colorado, Denver Health, National Jewish Health, and the Denver Veterans Affairs Medical Center. The school is located on the Anschutz Medical Campus, one of four campuses in the University of Colorado system. To learn more about the medical school's care, education, research and community engagement, visit its web site.