Tougher guidance on VA narcotics prescriptions headed to Obama's desk

A new law designed to curb opiate and heroin abuse includes tougher prescription guidance for Veterans Affairs medical facilities nationwide.

Sought by the family of Marine veteran Jason Simcakoski, who died of an accidental overdose at the Tomah, Wisconsin, VA Medical Center in 2014, the changes are designed to strengthen VA pain management guidance and training, improve prescription oversight and promote alternative therapies.

Under the bill, VA must ensure that its prescribers are schooled in the latest practices and that all medical facilities stock overdose countermeasures such as naloxone and establish pain management teams to oversee opioid prescriptions for veterans with non-cancer-related pain.

“The bill recognizes that too often, these drugs have been used inappropriately and ineffectively, and because they are so powerful and so addictive, this inappropriate use is very dangerous,” said Sen. Tammy Baldwin, D-Wis., a sponsor of the veterans provisions.

The Comprehensive Addiction and Recovery Act, which passed the Senate on Wednesday by a vote of 92-2 and is expected to be signed by President Obama, authorizes $181 million in new funding for a range of measures designed to fight the national opiate abuse epidemic.
The bill requires the VA to ensure health care providers can access and provide information to state prescription databases. It also gives patient advocates more independence by providing an avenue for reporting patient concerns outside the hospital’s chain of command.

It promotes alternatives to incarceration for those with substance abuse issues, to include grants to expand veterans treatment courts, and it broadens the number of health care providers who can oversee patients prescribed medications for opioid addiction by allowing some nurse practitioners and physician assistants to facilitate treatment.

Simcakoski died Aug. 30, 2014, in the Tomah hospital’s short-stay mental health unit from “mixed drug toxicity,” having taken 13 prescribed medications, including several that cause respiratory depression, in a 24-hour period.

Staff psychiatrists had added new medications to Simcakoski's lengthy list of prescriptions in the days preceding his death and according to Baldwin, both Simcakoski and his family members had questioned staff whether the treatment was appropriate.

Veterans also told a Center for Investigative Reporting journalist that distribution of narcotics was so rampant at Tomah, they nicknamed the place "Candy Land" and the center's chief of staff Dr. David Houlihan the "Candy Man."

According to Baldwin, the patient advocacy measures in the new legislation were most important to the Simcakoski family.
"In Jason's case, he and his family questioned the treatment. But nevertheless, the patient advocate answered to the prescribing physician and the hospital chief of staff. That’s not independence,” she said.

According to a 2014 VA inspector general report, the Veterans Health Administration issued 1.68 million prescriptions for opioids to 440,000 outpatients, or 7.7 percent of all VA patients, in 2012.

The IG found that 13.1 percent of those prescribed opioids had an active substance use issue and 7.4 percent of patients taking opioids also had a prescription for benzodiazepine — a combination that can cause respiratory depression and death.

In 2012, the Center for Investigative Reporting published an analysis showing that VA prescriptions for opiates such as hydrocodone, oxycodone, methadone and morphine have increased 270 percent over the past 12 years.

The investigation also found that on average, VA has issued more than one opiate prescription per narcotic-prescribed patient for the past two years.

Baldwin said the Simcakoski family worked hard to make sure the VA provisions were included in the final bill, and she praised their efforts.

"This bill may have a real impact on the chances of [a veteran] becoming addicted," Baldwin said. "My goal is to prevent Jason’s tragedy from happening to other veterans and their families."




Patricia Kime covers military and veterans health care and medicine for Military Times. She can be reached at [login to see] .