Healthcare Inspection – Alleged Inappropriate Opioid Prescribing Practices, Chillicothe VA Medical Center, Chillicothe, OH

The OIG conducted an inspection in response to allegations that physicians at the Chillicothe, OH, VA Medical Center prescribed opioid medications for patients they had never evaluated. In addition, patients were alleged to be at risk because no prescriber was monitoring them for adverse reactions, pain relief, or opioid abuse. We did not substantiate that physicians improperly prescribed opioid medications for patients whom they had not seen or examined. We did substantiate that physicians prescribed opioids for patients with whom they had no direct interaction, but this is not a violation of law or VA policy. We substantiated that physicians did not consistently document medication effectiveness prior to renewing prescriptions for patients at increased risk for adverse medication effects or diversion. We also found that physicians were not consistently documenting use of the Ohio Automated Rx Reporting System, a state prescription drug monitoring program. We did find that urine drug screens were routinely performed. According to Veterans Health Administration policy, patients on chronic opioid therapy are to be evaluated every 1 to 6 months. Although renewing opioid prescriptions without examining patients is not a violation of law or VA policy, a minimum review of patient information is required. Our review of 88 patients for whom opioids were prescribed in 2013 and 2014, and who were at increased risk for complications or abuse of opioids, revealed that physicians did not thoroughly assess patients before renewing opioid prescriptions. We recommended that the Facility Director ensure that patients receiving recurrent prescriptions for high potency and/or large quantities of opioid medications are routinely identified and provided appropriate follow-up care, and prescribing physicians review the prescription history reports contained in the Ohio Automated Rx Reporting System for patients who are prescribed opioids.