Cleveland VA Reduces Opioid Prescriptions Using Innovative Model

By Kelly Burch 09/19/17

The Cleveland VA has created a system that is helping to reduce the overall reliance on opioid painkillers for veterans with chronic pain.

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The Department of Veterans Affairs recently issued a report calling for changes to its system in order to reduce the risk of opioid overdose among veterans. But while nationally the VA struggles to stem the number of opioid prescriptions, the VA in Cleveland, Ohio has reduced opioid prescriptions by 25% since 2010 using a program that its director says is easily replicable. 

The Cleveland VA is on the frontline of the opioid epidemic, operating in a state that saw the number of unintentional drug overdoses increase by one-third last year, translating to more than 4,000 deaths. While other hospital systems in the region cut opioid prescriptions by less than 10%, and nationally by 12%, the Cleveland VA reduced opioid prescriptions by a quarter and cut the most potent and dangerous opioids in half, according to STAT News.  

“How the Cleveland VA system did that at a time when opioid overdose deaths are rising in the country overall may offer lessons for others as we come to grips with this preventable epidemic,” wrote Ali Mchaourab, MD, who oversees pain medicine at the Cleveland VA. Mchaourab co-authored the STAT article with two other physicians. 

Mchaourab says the Cleveland VA used technology to promote best practices for pain management such as adherence to evidence-based treatment and safe prescribing. These were used as a foundation for the VA Specialty Care Access Network-Extension for Community Health Care Outcomes (VA SCAN-ECHO), which Mchaourab leads in the Cleveland system. 

During weekly training sessions, pain management doctors taught primary care providers about how best to alleviate pain for their patients, and consulted on cases. There was a focus on treating pain with non-opioid medications as well as interventions, both invasive and non-invasive, to control pain. 

“In the wake of the program’s rollout, wisdom and expertise in evidence-based pain management have spread throughout the entire Cleveland VA primary care network, resulting in markedly diminished utilization of opioids to treat chronic pain,” Mchaourab wrote. 

He hopes to see the system replicated around the country. 

“Creating a culture of safe opioid prescribing requires knowledge, institutional investment, and a technological platform that facilitates interactions between health care workers who are involved in treating patients with acute and chronic pain,” he wrote. “The outcomes of the Cleveland VA approach to pain management demonstrates that it is possible to improve physicians’ opioid prescribing patterns. An approach like this could easily be replicated—and should be robustly evaluated—in other health care systems to help stem the tide of the opioid epidemic.”

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.