Prescribing drugs safely, the VA way

Jonathan Kaupanger
July 11, 2018 - 4:34 pm



Every day, more than 115 Americans die from overdosing on opioids. About 34 of these deaths are due to combining opioids with benzodiazepines. In the civilian healthcare world this combination is a big problem, but it’s something you don’t hear about often at Veterans Affairs.

Benzodiazepines have been used to treat a variety of disorders since the 1970’s. On their own, they rarely cause overdose deaths. Their comeback in the news is due to what happens when taken with an opioid. When mixed at overdose levels, the drugs can significantly slow or stop a person’s breathing and if not treated immediately can lead to coma and death. But again, you don’t hear about this much inside VA.

“It’s not that there isn’t an issue, the problem is that this issue is wide spread, it’s not just a VA problem,” says Dr. Smita Das, Director of Addiction Treatment Services at the Palo Alto VA in California. “What’s great at the VA is that because we have a network and we have a system and we’re held accountable to evidence based care and safe practices. There’s actually a much better safety net within the VA for safe prescribing.”

There are more resources available within the VA for safe prescribing because it’s a connected, centralized system. When working with patients, Dr. Das can access anything that’s prescribed by any VA provider around the country. In the civilian world, this isn’t true because prescription monitoring varies from state to state and in some cases region to region. 

For example Dr. Das works in California, if she didn’t work for VA she could only view her state in the Prescription Drug Monitoring Database (PDMD).  

“The beautiful thing about the VA system is that I can see VA prescriptions from anywhere, not just from California,” says Das. “Sometimes I will get patients from the community who might be seeing a doctor that’s not in a system like VA. That prescription list is a lot more concerning to me, than one in our VA community.”

Even with the limited usefulness of the PDMD, all doctors at VA are encouraged to routinely look at outside prescriptions. There have been some efforts to make the PDMD a national database, but logistics and state privacy laws are slowing the process.

“When something is concerning in the media, I’m always reassured because it’s almost as if the VA is one step ahead,” says Das. “We know that this is something that is risky because we’ve already seen this in our patients.  Things get on our radar very quickly!”

If you’re concerned about your medications, you can request a VA medication reconciliation. This is a way for you and your health care team to review your medicines to make sure they are helping rather than harming you. You can learn more about VA’s Pharmacy Benefits here.

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