Washington — Connecticut veterans are escaping the notice of a state program aimed at combating prescription drug abuse, an epidemic among those veterans; and the federal government’s Department of Veterans Affairs is to blame, a state official says.
The Drug Control Division, established as a part of Connecticut’s Department of Consumer Protection, runs the Connecticut Prescription Monitoring Program that oversees the entire pharmaceutical industry in the state, including wholesalers, prescribers, pharmacies and any other place drugs can be purchased.
While the division’s 12 agents are tasked with keeping an eye on the loss and diversion of all drugs, including controlled substances, the head of the agency, John Gadea, says there are gaping holes in the system.
“The problem in Connecticut is that we have the VA that does not upload data into our system, and that provides a Swiss-cheese approach to data,” he said. “It doesn’t help anybody.”
The state has two major VA facilities, in Newington and West Haven, and a number of smaller clinics that serve Connecticut’s more than 330,000 veterans.
Gadea says painkiller abuse usually occurs among “dual patients.” Those are veterans who are treated in VA facilities and also see private doctors. Because the VA doesn’t share information, prescribers “on the outside” don’t get a complete picture of what medications the veteran is taking, Gadea said.
Pamela R. Redmond, a spokeswoman for the VA Connecticut Healthcare System, declined to comment on Gadea’s criticisms, saying “collaboration in state prescription monitoring programs is governed by VA national policy.”
The VA says concerns about privacy have kept many of their doctors and facilities from participating in state prescription-monitoring programs, but it is working to eliminate those barriers.
Opioid abuse has become a hot-button issue after reports that doctors at the U.S. Department of Veterans Affairs medical center in Tomah, Wis., handed out so many narcotic painkillers that some veterans had taken to calling the place “Candy Land.” Last year, a 35-year-old Marine Corps veteran died of an overdose in the medical center’s psychiatric ward.
A recent study determined that nearly 100,000 veterans currently are receiving prescriptions for both tranquilizers and narcotic painkillers from VA facilities — a potentially deadly combination that is explicitly discouraged by agency guidelines.
About 30 percent of Americans who suffer from chronic pain abuse painkillers, but that figure jumps to 50 percent among veterans.
At a hearing in the Senate Veterans’ Affairs Committee co-chaired by Sen. Richard Blumenthal, D-Conn., last week, John Daigh of the VA’s Office of Inspector General said the VA has taken some steps to curb the problem.
But Daigh testified that the VA was not following its own policies and procedures in several areas, including evaluations of patients on take-home opioids.
“The data shows the VA was monitoring these patients very poorly,” he said.
Daigh said veterans with “complex, chronic pain issues,” including head trauma and post-traumatic stress disorder, are most at risk of painkiller abuse.
Privacy concerns
Blumenthal took the VA to task for failing to do more to protect veterans.
“This epidemic has been with us for years and years,” Blumenthal said. “That’s one reason for my anger and astonishment that the VA system isn’t doing better.”
Blumenthal also said he will investigate whether the problems that occurred in Tomah are happening in Connecticut.
Gadea testified that Connecticut’s drug-monitoring system can access data from 17 other states in addition to the 684 in-state and 872 out-of-state pharmacies, “but it cannot access the data from two (VA) campuses located within the boundaries of the state.”
He said he tried to meet with doctors and administrators at the West Haven VA facility to explain the state’s drug monitoring system and was told by a “privacy officer” to “never discuss (the issue) with physicians and to leave the premises and not return.”
Since that incident, Gadea said, VA physicians have been given access to the Connecticut Prescription Monitoring Program, “which is very, very good.” But the failure to upload their data “presents a problem,” he said.
Carolyn Clancy, interim VA Undersecretary for Health, told the Senate panel that the VA in 20 states cooperates with state drug-monitoring programs. Connecticut is among 29 states that have monitoring programs where the VA does not.
“We have identified that we have internal disagreements with some of our IT folks around privacy and security issues, which we will be resolving very promptly,” Clancy said.
Blumenthal asked her if it is compulsory for VA physicians to consult drug-monitoring program data in the 20 states where they are allowed to do so.
“Not yet, but it will be,” Clancy promised.
Blumenthal asked for a “definite timeline” for the implementation of the policy change.
Clancy also said that in the past 11 months, the VA has distributed about 2,400 narcotic overdose kits to family members or friends of patients who take opioid pain medications.
The kits contain the antidote naloxone, which, when injected or administered by nasal spray can reverse the respiratory depression that often causes death during an overdose.
Clancy said the kits have saved the lives of 41 veterans to date.