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Report: VA Physicians Not Checking For Adverse Reactions From Opioids

A government watchdog report shows that Veterans Affairs physicians aren’t properly checking the documentation system before prescribing and renewing opioids for patients.

This oversight leaves veterans at risk for adverse effects and narcotics abuse.

Investigators carefully examined the VA Chillicothe medical center located in Ohio after receiving allegations that physicians were prescribing opioids without even evaluating patients. On top of that, physicians were reportedly not monitoring veterans to see the effectiveness of the medication, or whether abuse or adverse reactions were occurring.

Not all of the allegations were true.

After a detailed site visit, investigators determined that there was no substance to the claim that physicians were prescribing opioids to patients they had never seen. However, physicians did at least renew prescriptions without seeing patients, but that is not directly against VA policy.

It may be somewhat of questionable procedure under the Ohio state code, given that the renewal without evaluation process should be restricted to very exceptional circumstances. It is unclear whether the VA restricted renewals without evaluations to exceptional circumstances.

In one example, the 90 day period before opiod renewal passed without patients having any interaction with medical professionals for 14 percent of 133 recurring prescriptions. An additional 14 percent had documented encounters with physicians, but there was no attempt to see if the medications were at all effective, or if veterans were suffering from substance abuse problems.

This last point was highlighted by the report, since of 88 increased-risk patients, 16 percent were at even higher risk for substance abuse. Four of the 14 patients either had no encounter or no documentation from a physician. Five were given extra prescriptions which have been linked to an increased risk of addiction when combined with traditional opioids.

The documentation system, named the Ohio Automated Rx Reporting System, showed that only in 43 percent of cases did physicians check to see if medications were effective or had adverse reactions when renewing prescriptions. However, physicians did require 85 percent of the 88 patients to undertake urine drug screens.

The Director of VA healthcare in Ohio neither objected to the findings nor the recommendations. In early 2015, patients receiving high potency opioids will be clearly identified and assessed at regular intervals. Physicians have also committed to checking the documentation system more thoroughly before prescribing medication.

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