As deaths from opioid overdoses skyrocket nationally, Veterans Affairs hospitals are seeking other ways of treating the chronic pain that many veterans suffer. The results are beginning to show in fewer prescriptions for opioid pain killers at VA medical facilities.
The Durham Veterans Affairs Health Care System reduced the number of patients who were prescribed the painkillers from 21 percent in 2012 to 12 percent in 2017, according to a Veterans Affairs interactive map.
The Durham facility now serves about 70,000 veterans, according to the hospital. In 2012, the center served 59,600 veterans. Currently, the Durham hospital has 5,081 veterans on opioid therapy, down from 6,509 in June.
Chronic pain is the most common ailment that VA doctors treat, said Brian Hayes, chief of primary care at at the Durham VA Health Care System. It affects about half of veterans, and three-fourths of women veterans, he said. In 2012, 2 million veterans nationally had some kind of chronic-pain diagnosis, and about a third of those patients were on opioids, Hayes said.
About 40 percent of returning veterans have post-traumatic stress syndrome, which further complicates pain treatment, he said.
Common prescription opioids include oxycodone, hydrocodone, morphine and methodone. They still have their place in treating some kinds of pain, but doctors are trying other methods to treat and alleviate long-term pain and help veterans settle into society, said Hayes.
In 2013 the Department of Veterans Affairs began the Opioid Safety Initiative. When the VA started the program, “I think it was this realization that we needed to be very proactive about what is now an epidemic,” Hayes said.
“There really is no safe dosage of an opioid,” Hayes said. “Any opioid can be addictive. Even a low dose can get you addicted,” While these drugs still have a role in treating acute pain, for the longer term, “Now opioids are not the first option,” he said.
Durham and other VA facilities are exploring other ways to alleviate pain that do not pose the addictive risks of opioids. Physical therapy, yoga, tai chi, acupuncture, and music therapy are among the treatments being offered. Medication is still used, but less powerful drugs such as acetaminophen and ibuprofen are now preferred, Hayes said.
The increase in abuse of opioids has prompted federal and state action.
In 2016, there were more than 63,600 drug overdose deaths in the United States, according to the federal Centers for Disease Control and Prevention, more than the number of Americans who died in the Vietnam War (about 58,000, according to the National Archives). In 2016, 40 percent of all opioid overdose deaths involved a prescription opioid, the Center reports.
The increase in deaths from opioids, including prescription pain killers as well as illegal drugs like heroin, has increased since 1999. In 2016, the number of overdose deaths involving opioids was five times higher than in 1999, the Centers for Disease Control and Prevention reports. From 2000 to 2016, more than 600,000 people died from drug overdoses.
The Center’s website puts much of the crisis in addiction on over-prescribing.
“The amount of prescription opioids sold to pharmacies, hospitals, and doctors’ offices nearly quadrupled from 1999 to 2010,” its website says, “yet there had not been an overall change in the amount of pain that Americans reported.”
Opioid prescription rates at N.C. VA hospitals
▪ Durham VA: 21 percent in 2012, 13 percent in 2017
▪ Salisbury VA: 18 percent 2012, 11 percent 2017
▪ Asheville VA: 26 percent 2012, 15 percent 2017
▪ Fayetteville VA: 21 percent 2012, 8 percent 2017
Source: Department of Veterans Affairs