State Prescription Drug Monitoring Programs Need Increased Use and Oversight

Report Information

Issue Date
Closure Date
Report Number
18-02830-164
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Audits and Evaluations
Report Type
Audit
Recommendations
8
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
Knowing a patient’s prescription history is essential to VA’s ongoing efforts to combating opioid abuse, overmedication, and deaths. The VA Office of Inspector General (OIG) conducted this audit to determine whether VA clinicians effectively used information from state-operated prescription drug monitoring programs (PDMPs) to manage and coordinate care for patients prescribed opioids. The OIG estimated that clinicians did not annually check PDMP databases for 73 percent of the 779,000 VA patients prescribed opioids between April 1, 2017, and March 31, 2018. Furthermore, VA clinicians should have considered whether 266,000 of the patients on long-term opioid therapy needed more frequent database queries. The OIG also estimated that 19 percent of VA patients prescribed opioids were at risk because VA clinicians did not perform the required query and were unaware of controlled substance prescriptions the patients may have obtained outside VA. The OIG concluded that the Veterans Health Administration (VHA) lacked effective internal controls to monitor and evaluate the performance of PDMP queries. Clinicians did not perform required queries because VHA did not effectively communicate its PDMP policy. Also, some medical facilities established less-stringent local policies, which were not reviewed to ensure they complied with VHA’s, and VHA did not address significant new developments or increased risks that affected its policy directive. Finally, the OIG found inadequate national VHA oversight and monitoring led to insufficient local monitoring and accountability at VA medical facilities. This occurred because VHA officials did not always consider PDMP queries a high priority as they implemented the Opioid Safety Initiative and focused on the reduction of VHA-issued opioid prescriptions. The OIG made eight recommendations to the under secretary for health related to strengthening VA’s policies regarding use of PDMP databases and ensuring VA leaders and clinicians understand and comply with those policies.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 2/17/2021
Develop national processes to oversee medical facility compliance with VHA Directive 1306, Querying State Prescription Drug Monitoring Programs, and coordinate the possible automated information technology solutions and inter-office and -disciplinary communications necessary to improve prescription drug monitoring program monitoring and usage in Veterans Health Administration.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 4/13/2021
Update the Pain Management and Opioid Safety training course to specifically address VHA Directive 1306, Querying State Prescription Drug Monitoring Programs, query requirements and recommendations.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 12/9/2021
Ensure VA clinicians who prescribe opioids take the Pain Management and Opioid Safety training once, with annual refresher training.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 9/1/2020
Add an addendum to VHA Directive 1306, Querying State Prescription Drug Monitoring Programs, that references the VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain and ensure VA clinicians are educated and receive annual training on the Clinical Practice Guideline, to include the Centers for Disease Control and Prevention’s recommended frequency for prescription drug monitoring program queries based on the patients’ risk factors.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 9/1/2020
Direct Veterans Integrated Service Networks and their VA medical facilities to ensure local policies are consistent with VHA Directive 1306, Querying State Prescription Drug Monitoring Programs.
No. 6
Closed and Implemented Recommendation Image, Checkmark
to Information and Technology (OIT)
Closure Date: 2/11/2021
Develop automated information technology solutions to facilitate clinicians’ access toprescription drug monitoring program query information and reinforce the need tocomplete minimum annual VA-required prescription drug monitoring program queries.
No. 7
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 2/11/2020
Ensure non-VA care clinicians are in good standing and have a current state medical license that requires adherence to their state’s prescription drug monitoring program query requirements; adhere to the Veterans Affairs Opioid Safety Initiative Guidelines, including guidelines for prescription drug monitoring program queries; and are monitored to ensure appropriate corrective actions are taken if their prescribing practices are found to be inconsistent with VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain.
No. 8
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 9/1/2020
Ensure Veterans Integrated Service Networks implement an effective prescription drug monitoring program oversight process that includes the review of compliance rates with medical facility directors.