Some opioid procedures not followed at Poplar Bluff VA center

POPLAR BLUFF, Mo. -- A limited inspection of the Poplar Bluff VA's opioid drug management practices found some procedures were not followed, but local officials said the results do not reflect changes made at the facility in the past 15 months.

The release of findings comes after the John J. Pershing VA Medical Center came under fire in recent months because of complaints from pain-management doctor Dale Klein, who was critical of procedures regarding narcotics management.

The Department of Veterans Affairs said an inspection was conducted in January 2016 because of anonymous claims. The VA did not give specifics about the claims in a news release last week, but it said they had to do with opioids. Opioids include prescription pain relievers such as hydrocodone, codeine and oxycodone.

The Office of Inspector General did not conduct a random sample but reviewed 10 veterans selected by the complainant.

Of these, six did not have urine drug screens performed as recommended. Five had not signed informed consents before beginning long-term drug therapy.

Providers also prescribed the drugs without documenting risk through a risk-stratification tool, according to the inspector general.

The Office of Inspector General made recommendations to resolve these issues, and Pershing staff said they have complied.

Better communication with providers outside the VA system was among the changes. The providers need timely notifications of clinically significant changes that could affect the patient's prescription, the inspector general said.

A pain-management clinic pharmacy specialist also is supposed to assist providers with tapering patients off opioids.

More education will be given to providers about the risks of opioids, and a committee monitors the completion of informed consents.

More steps were to be put into place to ensure urine drug screenings were performed and interpreted correctly. A committee regularly reviews completion rates, according to the VA.

An audit process was developed, and the most recent results showed all four patients had completed the urine test, the VA says.

The Office of Inspector General created an Opiate Safety Initiative in 2014 to address concerns about the use and abuse of narcotics.

At the time the initiative was created, the Poplar Bluff VA provided opiate therapy to about 1,500 veterans each year, local officials said. Very few underwent urine drug tests or signed consent forms, officials said.

By January 2016, the VA says they had achieved remarkable results.

The number of chronic opioid patients receiving urine drug screens went from less than 40 percent in mid-2015 to more than 80 percent since late 2015, according to figures provided by the VA.

The number of patients receiving opioids fell by 5 percent since January 2015, and the number of veterans on long-term opioid therapy dropped by 450 people.

The facility was awarded a $250,000 grant to develop opioid safety programs and procedures. It would include a team to work with primary-care providers and working with veterans to find ways to reduce drug reliance and coordinate care.