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VA Maryland Health Care System


Health Watch: Fall Winter 2017-2018

The Skinny about Opioids

Patients struggling with pain who are taking prescription opioids are among those dying from opioid-related overdoses, often unintentionally. With 6 out of 10 overdose deaths related to opioids—and that number rising—the VA is taking steps to protect Veterans.

Battlefield Acupuncture
Battlefield Acupuncture is the application of small needles to a patient's ear that can provide relief where prescription painkillers have failed and it does not impact a Veteran's ability to function.

"Evidence-based medicine proves that opioids are not a good treatment choice for pain, and in fact, these drugs fail to improve functionality or quality of life for pain sufferers," said Dr. Amit Khosla, Associate Chief of Staff for the Ambulatory & Emergency Care Clinical Center at the VA Maryland Health Care System. "Opioids can serve as a vital treatment for patients suffering from pain due to cancer and for those in hospice care, but opioids do not best serve people suffering with chronic pain."

Because the body develops a tolerance to opioids, it can trigger the addiction cycle, meaning that the same amount of medication no longer has the same effect, and patients struggling with chronic pain take more to gain the desired effect.

Just as the use of antibiotics has shifted, clinicians are taking steps to ensure that the use of opioids meet standards of care. At the VA Maryland Health Care System, clinicians are deploying the Opioid Safety Initiative to ensure that opioids are used in a safe, effective and careful manner.

Battlefield Acupuncture

In Battlefield Acupuncture, single use needles stay in the ear for a few days, and Veterans are finding them surprisingly successful.

First, new software mandated by the State of Maryland—CRISP—helps clinicians identify patients who are obtaining opioids from the VA and from community providers. "Letters are being sent to Veterans who receive opioids from community providers saying that their VA prescription will be discontinued. This prevents 'double-dipping.' VA providers are closing the gap between community and VA care," said Dr. Debra Khani-Mevorach, a VA physician who is part of the pain management team. "These patients are already seeing a community provider for pain care so they are not being left without any care, and we can offer them same day appointments if they need urgent care."

Second, patients whose opioid dosage exceeds a certain level will be referred to Dr. Robert Lavin, Director of the Chronic Pain Clinic, where a variety of holistic treatments for pain—such as yoga, battlefield acupuncture, mindfulness, and other options—are recommended.

Lavin and his Pain Clinic team are developing the Empower Veterans Program (EVP). "This program coaches Veterans with chronic pain to live a fuller life by moving toward their own wellness goals. The EVP team is made up of a pain psychologist trained in Acceptance and Commitment Therapy; a physical therapist trained in Mindful Movement (that includes yoga and tai chi); a chaplain trained in Mindfulness and Whole Health; and a social worker to assist Veterans individually and to address barriers to achieving their goals," Lavin said.

This interdisciplinary team takes a more holistic approach when treating pain, and Veterans are empowered to develop an approach to wellness as a whole person by addressing issues that impact the experience of pain, such as sleep, nutrition, and rebuilding relationships, among others. EVP is a ten-week long program that meets for three hours each week.

Finally, clinicians at the VA Maryland Health Care System are committed to keeping patients safe by educating them and their families about the proper use of Naloxone, a drug that reverses an overdose and saves lives. In the past few years, the VA Maryland Health Care System has doubled the number of Naloxone kits distributed to patients taking opioids and their families.

Any long-term use of opioids can put patients at an increased risk for an unintentional overdose, especially when they are taking other medications.

"Our initiative will keep Veterans safe from becoming dependent on opioids and improve quality of life by introducing other techniques and treatments to combat pain," Khosla said.

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