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Amy Kilbourne, PhD, MPH, Director of QUERI

Director's Letter

VA Innovations in Addressing the Opioid Crisis

Last year, a landmark article published in the Proceedings of the National Academy of Sciences (PNAS) by Anne Case and Angus Deaton (Princeton University) found rising mortality rates, especially among middle-aged whites.¹ The increase in mortality was largely attributed to preventable causes including suicide, chronic liver disease, and poisonings from opioid misuse. Similar findings were found in a recent article on Veteran patients from 2000-2011,² further adding evidence toward this alarming trend in opioid misuse and its dire consequences.

VA, with its integrated healthcare system and embedded research enterprise, is poised to address the challenge of the current opioid crisis head on. This issue provides examples of innovative strategies in addressing the opioid epidemic that are also in response to major policy initiatives, such as the Comprehensive Addiction and Recovery Act of 2016 (CARA). More importantly, VA's Quality Enhancement Research Initiative (QUERI) is rigorously evaluating novel programs implemented by VA nationally to address the opioid epidemic, including the Opioid Safety Initiative (OSI).³ QUERI is also at the forefront of developing and deploying strategies to support frontline providers in implementing effective practices to combat the epidemic using quality improvement methods toward effective pain management. The strategies described below include the use of measurement science to support integrated pain treatment in primary care, academic detailing to promote safe prescribing practices for Veterans with chronic pain, and the implementation of virtual expertise for primary care providers to access specialist guidance on effective pain treatments through the Specialty Care Access Network-ECHO (SCAN-ECHO) program.

In addition, QUERI has partnered with VA's Office of Patient-Centered Care and Cultural Transformation (OPCC-CT) to close the research-to-practice gap in deploying novel and effective non-opioid pain treatments. With funding from OPCC-CT, QUERI is supporting a rigorous assessment of complementary and integrative health (CIH) treatments, as well as the broader Whole Health Partnership (WHP) Programs that center on the goals and needs of each Veteran. These initiatives also are supported through ongoing partnerships between VA's Office of Research and Development (ORD), the Department of Defense (DoD), and the National Institutes of Health (NIH) through cross-agency requests for applications for Complementary & Integrative Health for Pain and the NIH-DoD-VA Pain Management Collaboratory, HSR&D's recent State-of-the-Art Conference on Non-Opioid Pain Treatments, and QUERI Evidence-based Synthesis Programs on CIH.

Ultimately, QUERI works at the intersection between research rigor and real-world VA practice to conduct rigorous national evaluations of new programs and policies, as well as the scale up and spread of best practices for pain management, to ultimately help reduce the opioid crisis and improve the lives of Veterans.

Amy Kilbourne, PhD, MPH
Director, Quality Enhancement Research Initiative

References:

1. Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, U S A. 2015;112(49):15078-83

2. Larney S, Bohnert AS, Ganoczy D, et al. Mortality among older adults with opioid use disorders in the Veteran's Health Administration, 2000-2011. Drug and Alcohol Dependence. February 1, 2015;147:32-37.

3. Lin A, Bohnert A, Kerns R, et al. Impact of VA Opioid Safety Initiative on Opioid Prescribing- Veterans. Pain (in press, 2017)