VA Docs Defied Opiate Rules in Treating Vets, Audit Finds

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VA medical centers defied some agency policies on supplying opiates to veterans in 2012, including simultaneously prescribing thousands of ex-troops with narcotic painkillers and psychoactive drugs -– a combination that’s been linked to lethal overdoses, a new audit shows.

The review, conducted by the independent Veterans Affairs Office of Inspector General (OIG), found that 92.6 percent of veterans who are chronically prescribed opioid drugs (such as Oxycodone) also were prescribed benzodiazepines (such as Xanax and Valium) -– a mix “strongly associated with death from opioid overdose.”

The audit, which collected data from a population of about a half million veterans, was first reported on by the Center for Investigative Reporting.

In addition, about one third of the veterans prescribed opioids “were on take-home opioids for more than 90 days,” the audit showed.

The U.S. Department of Veterans Affairs' own clinical practice guidelines already urge, the auditors note, “more careful monitoring of opioid patients treated with benzodiazepines as co-administration of these products may result in adverse drug interactions.”

“As someone that was being over-prescribed medication for my PTSD for years, this audit is not surprising at all."

Among the VA’s “take-home opioid patients,” 7,426 died in fiscal year 2012, states the report, which did not breakdown the causes of those deaths.

The audit –- requested by the Senate Committee on Veterans Affairs –- also found that while VA rules mandate veterans prescribed opiates undergo urine pre-tests to block addiction, only 7.6 percent of new veteran patients were given a urine drug test within 30 days prior to initiating their opioid therapy.

"The Department of Veterans Affairs concurs with the Inspector General’s recommendations and agrees that safe prescribing of all medications, including acetaminophen, is an essential aspect of patient safety," said Ndidi Mojay, a spokeswoman for the VA. "VA has taken steps to enhance prescribing and prescription fulfillment processes to prevent the types of situations described by OIG and to meet OIG’s intent to ensure safe prescribing of opioids."

Some Iraq and Afghanistan veterans interviewed by NBC News have complained that VA doctors over-prescribed them pharmaceutical drugs in attempts to treat their diagnosed cases of Post Traumatic Stress Disorder, but the pills didn't help or, in some, seemed to worsen their symptoms.

“As someone that was being over-prescribed medication for my PTSD for years, this audit is not surprising at all,” said Sean Azzariti, 32, a retired Marine and Iraq veteran who lives near Denver. He uses cannabis to self-treat his post-traumatic stress symptoms and has openly pushed for other veterans to receive legal access to marijuana for their ailments.

“The main reason behind all of the advocating I've been doing for years is to try and provide an alternative to the excessive amount of pills that is being prescribed to our veterans. It's truly a travesty,” Azzariti said. “I believe that this audit coming to light will finally show people just how irresponsible the VA has been with the lives of our veterans.”

The IG auditors’ recommended that the VA’s under secretary for health ensure that:

• “VA’s practice of routine and random urine drug tests prior to initiating and during take-home opioid therapy to confirm the appropriate use of opioids is in alignment with acceptable standards."

• “Opioid patients with active (not in remission) substance use receive treatment for substance use concurrently with urine drug tests.”

• “VA’s practice of prescribing and dispensing benzodiazepines concurrently with opioids is in alignment with acceptable standards.”

“I have reviewed the draft report and concur with the report’s recommendations,” wrote Dr. Robert A. Petzel, the VA’s under secretary for health, in a letter released with the IG audit.

Petzel noted that the report provides “important baseline data for understanding how (VA) practitioners were prescribing opioids two years ago.” Since then, he added, VA has initiated several new programs for improving pain care, including: “pain schools, tele-pain schools, smartphone type applications,” and that between October 2012 and November 2013 and, there were 39,088 fewer veterans receiving an opioid prescription from VA.

“VA expects these trends to continue,” Petzel said, “as it promotes the safe and effective pharmacologic and non-pharmacologic stepped care model of pain management.”