Indiana VA Hospital Cuts Opioids for All Vets
Would you ever think that a hospital created solely for vets would suddenly cut the opioid pain management program without a heads up?
Well, it happened.
It was November 30, 2015, when the Federal Drug Enforcement Agency (DEA) raided the inside of Marion Veteran Affairs Medical Center in Marion, Indiana.
Local news, Fox59, reported on the matter in one of its daily segments where they announced, "The warrant reveals that the VA in Marion purchased more powerful and addictive prescription pills than any other facility in the northern district. There have been no arrests or allegations of wrongdoing, but the DEA wants to know why the hospital is ordering such large quantities."
The DEA was in search of patient records and the corresponding prescribing practices of physicians at the VA. The focus of their investigation was not on the patients themselves, but rather why the hospital workers are ordering so many pills.
Most medical practices use a database called Inspect to hold prescribers accountable for what they are dispensing and to keep records of everything coming and going. Because there's no record of these prescribing practices, the DEA red flagged this location and spent hours investigating. Hence the need for their official warrant and search.
According to government records, the hospital purchased 832,310 pills of hydrocodone in 2014. And, within the first three quarters of 2015, the quantity of hydrocodone progressed into more than one million pills.
The hospital comptrollers called the DEA's investigation "routine" partially due to the fact that they treat 26,442 "unique" patients.
It makes sense. Veterans come home from war with battle wounds, large and small, pretty much unimaginable. So we understand their need for pain relief through an opioid regime. And remember Backers, like you, these pills are provided by a doctor and then hopefully taken as prescribed.
Flash forward to May 23, 2017.
The previously investigated hospital accused of handing out opioids too freely is now cutting off prescriptions without ample notice or word from their primary doctors.
Remember, this hospital is for veterans and most of them count on these pills for pain management.
Fox59 reported that three patients consented to speak on the issue— Josh Keller, Rae Ann Panther, and John Nelson— who described the VA’s removal of the opioid program “irresponsible” and “dangerous.”
“They’re treating us like we’re addicts selling our prescriptions on the street,” Nelson offered.
Nelson, paired with the two others, recognizes that some patients are indeed addicts and may be selling their prescriptions or addicted themselves. The ones who came forward are concerned that providers will assume that "everyone is an addict and will treat everyone poorly because of that."
“None of us wants the drugs for the high,” responded Panther. “We just want to live again.”
What Does this Mean for the Present?
Now, the three are left to grapple with their pain in addition to opioid withdrawal because of the sudden cutoff, which came just a day or two before their prescriptions ran out. The three received zero assistance with weening off their Schedule II narcotic. Opioid withdrawal is like the flu on steroids.
Examples of Schedule II Narcotics include:
- Hydromorphone (Dilaudid)
- Methadone (Dolophine)
- Meperidine (Demerol)
- Oxycodone (OxyContin and Percocet)
- Fentanyl (Sublimaze and Duragesic)
Other Schedule II Narcotics include:
Furthermore, cutting off the opioids means no relief for their chronic back and knee pain — something that they've spent years trying to forget while working towards recovery.
“I called back several times and finally got a nurse to say, 'They’re not giving you any of your medication. I am extremely sorry,'" Keller recounted the day he discovered his prescription would not be refilled.
“She (the nurse) was very upset. It sounded like she was in tears. She explained to me, 'They’ve done it to not just you, but everybody. They’ve done this to everybody.’"
Panther had a comparable encounter as a retired nurse herself. She recalled that the most unnerving aspect of this all is the radio silence from the doctors.
“They never contacted me to say, 'Hey, we’re thinking about doing something [new], what’s your idea?'” Panther revealed. “No plan of action. [They] Cut you off, and never talk with you about it [again].”
Nelson on the other end is self-employed. Today, he's unable to work.
For Keller, this means doing away with reserved vacation days because he's so in much pain, he cannot get out of bed or think about going to work.
“I have to weigh my options,” Keller emphasized. “Am I going to be sick? Can I call in sick today or is it going to be worse tomorrow?”
Panther's husband recently had to quit his job to help take care of her because of numerous chronic illnesses paired with her pain — making her bad situation into something much worse.
“There’s no quality of life for people like us!” Panther shouted. “When they say, your pain level from 1-10. Dear God, what’s a 1? We live probably at a 4.”
The three said that Chief of Staff, Dr. Lori Drumm is the one making these decisions. She has never even met the three nor anyone else for that matter.
Drumm refused to comment on camera with Fox59, but they were able to get a word from her boss, Dr. Wayne McBride.
Why is This Really Happening?
“Dr. Drumm is a very experienced primary care provider and she is our service chief for the primary care service line,” McBride affirmed, appearing to have his coworkers back.
He reported that part of Drumm's role is to ensure that providers are adjusting their care with the national VA Opioid Safety Initiative.
There are two principal grounds Drumm submitted as cause for this pill modification.
- Seldom, McBride remarks that upon reviewing patient records, she most likely found a violation of someone's “pain contract” by using opiates improperly. When a veterans’ urinalysis comes back negative when it's supposed to be positive, it might indicate they’re averting their drugs and/or selling them to someone else.
- Drumm also recommends change when she believes the prescribed dosage is exceedingly high.
So when McBride asked why these vets were only now learning of the modifications/removals of their scripts from Drumm and not their personal provider, McBride surprisingly commiserated with them.
How Can it be Made Right Again?
“I’m concerned, when the veteran has not received the communication from the assigned provider and Dr. Drumm is scripting this care or making those determinations.” said McBride.
He spoke with Panther about the lack of discussion and was genuinely upset.
"This is not the way [I] want these conversations to happen. It’s disturbing that she wouldn’t say, ‘Come in let`s talk about this,'" McBride added.
His intent is for all opiate modifications to always comply with the Opioid Safety Initiative.
“In many chronic pain conditions, opioid medications are now not thought to be the standard of care,” declared McBride. “It is our intent before we reduce the medication to make sure they have pain management from other sources, non-narcotic sources, where they will have access to chiropractic or physical therapy.”
Is There an Opioid Alternative?
Those alternatives pain include acupuncture, physical therapy, massage therapy, aqua therapy or even seeing a psychiatrist, as they slowly taper off their opiates.
But this doesn’t match the chronicles from these three veterans (and many others who have not yet come forward).
“I’ve spent almost $1,200 of my own money using a doctor for acupuncture and chiropractic [care],” Panther mentioned. “We ask them about it and they say, 'Oh no you don’t need that.' I’ve had a doctor say to me, 'I don’t believe in that stuff.' I would believe in anything that helps me!”
McBride maintains that he doesn’t want to see veterans going into their own pockets when they should be receiving the treatment through the VA or other state funded programs. He did admit that alternative pain care appointments aren’t always the easiest to come by.
In addition, the fact that some physicians aren't following protocol to properly wean veterans off their opiates is a matter of concern. The law explicitly demands safe weaning practices, no matter the basis for the prescription removal.
McBride believes fear may be a motivating factor as to why providers are moving so swiftly. Nevertheless, these veterans feel their providers are placing their and other veterans’ lives in jeopardy.
Closing it Out
“That’s why there are 22 veterans committing suicide every single day,” Panther recalled. “Chronic pain is a killer. And in my opinion, these programs where they`re just abruptly taking medication from patients that absolutely need it, this is the cause.”
McBride points out doctors are holding a lot of pressure to curtail the number of opiates they are prescribing, which is key as to why some may be operating the way they are.
Under the latest Comprehensive Addiction Recovery Act authored by Indiana Representative Jackie Walorski, "The number of opiate prescriptions provided by doctors and at VA facilities will be under review each year, starting with a report set to be filed this summer. These doctors’ prescription numbers will be under a microscope, in an attempt to keep veterans from getting hooked on the drugs in the first place."
Her office is concerned about the reports of sudden cutoffs throughout the Northern Indiana VA system.
They plan to ensure that all issues will be addressed by working together with the Marion facility, speaking to patients and doctors alike.
Ironically, after Fox59 published several stories, the hospital received that many more complaints.
The goal is to stop this nationwide epidemic. So let's hope that the hospital created solely for vets who suddenly cut their opioid pain management program figures out a plan to manage this all. And next time, give those vets a heads up!
If an update is received — expect to be alerted by your BN team.