Better Communication and Oversight Could Improve How the Pain Management, Opioid Safety, and Prescription Drug Monitoring Program Manages Funds

Congress enacted the Comprehensive Addiction and Recovery Act (CARA) of 2016 to improve opioid therapy and pain management for veterans. Within CARA, the Jason Simcakoski Memorial and Promise Act (Jason’s Law) requires each Veterans Health Administration (VHA) medical facility to have a pain management team (PMT) to coordinate and oversee pain management therapy. The Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) was established in part to ensure the requirements of CARA and Jason’s Law are met.

In fiscal years (FY) 2022 through 2024, the PMOP received $647 million in specific purpose funds to support pain management and opioid safety programs primarily at the medical-facility level. However, the PMOP returned about $126.7 million unused in FYs 2022 and 2023. The VA Office of Inspector General (OIG) conducted this audit to evaluate the PMOP’s management of specific purpose funds.

The OIG found the PMOP did not always effectively communicate with VISNs and medical centers so that they could plan for efficient use of funds. In addition, the program did not always communicate important funding information with key officials before allocating funding. Finally, VHA and the PMOP need to strengthen oversight to ensure fully compliant PMTs are in place at each VHA facility.

The OIG made five recommendations to the under secretary for health. The OIG agreed to close two; VHA has already taken sufficient action related to instructing the PMOP to communicate pertinent funding information with key staff before the start of the next fiscal year. VHA also agreed to ensure the program clarifies and defines PMT requirements and establishes a way to periodically validate PMT information and to require the program and the chief operating officer to address each medical facility’s lack of progress in achieving a PMT.