The U.S. Department of Veterans Affairs has systematically failed to follow its own rules governing the prescription of addictive narcotic painkillers, contributing to overdoses and deaths, according to 68-page report released today by the agency’s inspector general.
The audit comes a day before Secretary of Veterans Affairs Eric Shinseki is to testify before a Senate committee to answer allegations that dozens of veterans in Phoenix died waiting for care.
“They don’t know what they’re doing. They don’t care,” said Steven Harvey, a 57-year-old Army veteran who was sent home with morphine even after he fell into a coma when he was given 10 times the recommended dose of the painkiller fentanyl during a routine procedure to remove a kidney stone at a Los Angeles VA in August 2012.
The inspector general reviewed patient records for nearly a half-million veterans prescribed opiates in 2012 and found widespread problems:
- More than 90 percent of veterans regularly prescribed opiates also were prescribed benzodiazepine muscle relaxants, even though taking the two together increases the likelihood of overdose and death.
- VA policy requires that veterans being prescribed opiates receive urine tests to prevent abuse, but less than 8 percent of new patients were screened.
- Thirteen percent of veterans receiving opiate prescriptions were known addicts.
- A majority of veterans on opiates have post-traumatic stress disorder or another mental health condition, but a national policy discourages narcotic prescriptions for these patients because of their increased risk of overdose.
- Although psychotherapy is recommended to relieve pain, about 45 percent of veterans on opiates were receiving it.
The VA did not immediately return calls for comment on the auditor’s report. In his written response, the agency’s undersecretary for health, Dr. Robert Petzel, agreed with the inspector general’s findings, saying the report “provides an important baseline for understanding” how VA clinicians were prescribing opiates two years ago.
“Since that time,” he said, the VA “has initiated several new modalities for improving patients care, including: pain schools, tele-pain schools, smartphone type applications and web based modules for patient family education, case based audio conference, nationwide community of practice calls, self-management strategies, and complementary and integrative medicine modalities.”
By last November, he said, about 39,000 fewer veterans were on opiates than in October 2012.
The audit of the VA’s prescription practices comes as the agency faces increased scrutiny from members of Congress and veterans’ advocates over reports that VA officials in Arizona, Colorado and Texas manipulated data or maintained secret lists to hide lengthy wait times for medical care.
The American Legion, the nation’s largest veterans group, has called for Shinseki’s resignation.
Even before this latest scandal emerged, the agency’s prescription practices were under fire from members of Congress.
In September, The Center for Investigative Reporting revealed that VA prescriptions for four highly addictive opiates – hydrocodone, oxycodone, methadone and morphine – surged by 270 percent between 2001 and 2012. That far outpaced the increase in patients and contributed to a fatal overdose rate among VA patients that was nearly double the national average.
At a congressional hearing in October, VA officials promised to combat the problem. In February, VA officials told members of the House Committee on Veterans’ Affairs that the number of veterans being prescribed opiates had fallen by 20,000 during the previous four months.
At that hearing, Petzel said the VA would expand alternative pain therapies, including acupuncture, meditation, yoga and imaging therapy.
But in interviews this week, veterans said that while VA doctors have become more conservative in prescribing narcotics, alternative therapies have yet to materialize.
“They don’t offer anything but pills,” said Iraq War veteran Ryan Holleran, 28, who was discharged from the military last year.
Holleran said he was put on Vicodin in the Army for chronic back pain from carrying a 75-pound backpack in Iraq. Holleran said he has turned down narcotic prescriptions at the VA despite continued pain.
Now, he says, he takes large amounts of ibuprofen prescribed by the VA in San Francisco – so much, in fact, that an agency doctor prescribed him another medicine to protect his stomach lining. He also takes an antidepressant and an antipsychotic prescribed by the VA, he said, but receives no therapy.
Holleran said he was turned away from yoga. The only class offered, he said, was for VA employees. The San Francisco VA did not respond to a request for comment.