Senate committee wants VA to ensure providers work to prevent opioid abuse

After a Veterans Affairs inspector general’s report found that nearly 15,000 providers have been prescribing opioids despite not having completed training to help prevent potential abuse or overdoses from the drugs, Senate Veterans Affairs Committee members want action.

Committee Chairman Jon Tester, D-Mont., and Sens. Angus King, I-Maine, Patty Murray, D-Wash., Mazie K. Hirono, D-Hawaii, Tammy Baldwin, D-Wis., and Jacky Rosen, D-Nev., penned a letter to Veterans Affairs Secretary Denis McDonough on Friday, calling for the department to take action to ensure that third-party providers are following drug-monitoring guidance before prescribing opioids to veterans. 

“VA owes it to those in its care to take every prescribing precaution necessary as our country faces the ravages of the opioid epidemic,” the letter said. “As stated many times before, we feel if there is an issue at one location, it will likely occur elsewhere. The department must work not only to address the shortcomings outlined in these OIG reports but also to ensure lessons learned are implemented system-wide.”

This comes as a September OIG report found that nearly 81% of non-VA providers in the department’s Community Care Network — which provides veteran health care outside of VA facilities — had not completed required training for opioid risk-mitigation strategies in fiscal 2021. Some providers also failed to check state prescription databases to ensure veterans weren’t already prescribed opioids, the report said.

Monday’s letter stressed the failure to monitor PDMP queries as a key concern for the committee, pointing to a second OIG report that found that veterans in the VA Eastern Kansas Health Care System were dually prescribed opioids and benzodiazepines from VA and CCN providers due to similar lapses in oversight.

The VA issued 3.2 million opioid prescriptions to approximately 577,000 veterans in fiscal 2021, with 146,000 prescriptions coming from non-VA healthcare providers to roughly 48,100 veterans. 

The 2018 VA Maintaining Internal Systems and Strengthening Integrated Outside Networks, or MISSION, Act requires the department’s Office of Integrated Veteran Care to ensure providers have received its Opioid Safety Initiative guidelines, including opioid risk-mitigation strategies, to be part of the CCN. 

CCN contracts also require providers to check state prescription drug monitoring programs — databases maintained to track controlled substance prescriptions — before writing an “urgent/emergent prescription for a controlled substance.”

One OIG report found that while a contract provision for one of the VA’s third-party administrators required it to ensure that prescribing providers reviewed the OSI guidelines, the contract for a second administrator did not. 

Neither administrator, TriWest or Optum, was required by contract to monitor whether providers certified their OSI guidelines review, despite the IVC acting deputy chief for contract administration believing the administrators were responsible for ensuring that providers completed the training. 

“Consequently, neither VA nor the third-party administrators monitored training completion,” the report said. “VA contracting officers for the CCN contracts stated that the contract provisions were not in compliance with the MISSION Act OSI training requirements and that the third-party administrators were in compliance with the contracts as currently written because they were only required to make the training available.”

IVC also did not monitor whether all of their third-party providers completed queries of state PDMPs with some providers saying they were unaware of the requirements. 

The OIG recommended that VA strengthen controls to monitor third-party administrators' role in assuring OSI training guidelines and state PDMP queries are completed, which the department concurred with.   

However, Monday’s letter pressed McDonough for VA’s plans to ensure state PDMP queries, require OSI risk mitigation strategy documentation and asked that the VA revisit a recommendation from the Eastern Kansas OIG report that called for formal guidance to be provided to all Veterans Health Administration pharmacy staff to also conduct PDMP queries, which the VA did not concur with in its response to the report. 

“It is the responsibility of VA to ensure the veterans in its care, or that of its community partners, are being provided high-quality care. We urge VA to act to ensure our nation’s veterans are not put at risk when seeking care in the community,” the letter said. 

“Too often we have seen findings in one hospital, one state or one [Veterans Integrated Services Network] point to a larger problem across the system. Given community providers are not consistently querying PDMPs themselves, VA must step in to protect veterans. VA can outsource the work – but it cannot outsource the responsibility for taking care of veterans.”