Effective Strategies For Opioid Management In Government Agencies

Relieving service members’ and veterans’ pain while guiding them away from addiction

Red Ribbon Week, which begins on October 23, is the nation’s largest and longest-running substance use prevention campaign and provides an opportunity to focus on the importance of living a drug-free life. While it is primarily a moment for parents, educators, and communities to reinforce drug-free messages with children, it’s also a chance to learn more about the destructive effects of abusing both illegal and prescription drugs.

This year’s Red Ribbon Week comes at a time when the opioid crisis continues to be a significant challenge for communities across the United States. This struggle has permeated all layers of society including within government agencies, and among military service members and veterans. Opioid misuse, or opioid use disorder (OUD), among military personnel and veterans is a significant public health issue that is driven by many factors including chronic pain management and mental health disorders.

Combat veterans have experienced an especially impactful physical and psychological toll that only intensified as they transitioned back to civilian life. As in civilian healthcare up until the early-2010s, opioids were often used as one of the first-line therapies to treat veterans for pain, leading to a key aspect of the opioid crisis we have today.

Complying with Federal and DoD opioid safety recommendations

Government agencies can help stem the challenge of addiction with the right strategies to effectively manage opioids. It starts with ensuring compliance with Federal and Department of Defense (DoD) opioid safety recommendations and requirements.

VA/DoD clinical practice guidelines for opioid therapy to treat chronic pain includes recommendations for opioid dosage, monitoring, and tapering. For example, these guidelines recommend against long-acting opioids for acute pain and suggest a collaborative patient-centered approach. The VA/DoD guidelines for the management of substance use disorders also provides helpful tips, and suggestions for medication-assisted treatment for OUD, which should be referenced consistently.

The DoD also provides approaches to mitigate opioid risk at the outset of treatment. This is where comprehensive biopsychosocial pain assessment comes into play and examines the underlying physiological, psychological, and social factors influencing the condition. Moving beyond treatment, assessing risks and benefits during opioid use is critical and includes periodic urine drug screening, using a prescription drug monitoring program, and opting for opioid alternatives when possible.

Utilizing data analytics to identify at-risk individuals early

Most people are able to recover from a serious injury or surgery with a medication regimen that includes only a short course of opioid medications. However, for approximately ten percent of the population, the pain experience can initiate a downward spiral of both physical and mental health outcomes, that could contribute to the development of an OUD. It is critical for healthcare providers to identify those that might be at risk of these poor physical and mental health outcomes early so they can guide them properly and reduce the chance for opioid misuse and addiction.

Identifying these patients takes the training and experience of a medical expert. One tool to potentially deploy in this effort can be a simple two question survey. A Duke Integrated Pain and Wellness Program study revealed that a brief, very specific questionnaire can identify people most likely to develop chronic pain. The questions are:

Have you ever felt your pain is terrible and it’s never going to get any better? (Y/N)
Have you ever used an illegal drug or prescription medication for non-medical reasons? (Y/N)

Once identified, these patients can be guided through holistic pain management services that lead to better outcomes.

Recommendations for delivering effective treatment plans for OUD

OUD requires coordination among all healthcare providers. Once OUD is identified within a patient, the first step involves shared decision making to coordinate a plan for addressing any active intoxication or withdrawal. The severity of the OUD will guide treatment setting and pharmacotherapy options, with FDA-approved medications. These include buprenorphine for office-based management and treatment, and naltrexone and methadone that is administered to more complicated patients at dedicated substance use disorder specialty practices.

Psychotherapy should also be available for all individuals receiving medication-assisted treatment for OUD particularly due to the frequent prevalence of underlying trauma, anxiety, and depression, specifically in veterans. Talk therapy and counseling during recovery has proven to be effective and should be part of the plan. Patients should also be encouraged to take advantage of the existing community-based approaches for drug addiction such as peer-support meetings and therapeutic housing.

Whatever the specifics of the individual challenge and approach, opioid addiction is a treatable, manageable condition that takes time and resources to address. Servicemembers and veterans deserve a satisfying, productive, enjoyable life where they can ameliorate or manage their chronic pain effectively. It’s key to educate ourselves on the destructive effects opioids are having on this community and lend support to those who need it most.