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Addressing the opioid epidemic in the United States

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The Department of Veterans Affairs (VA) serves a population that has been grossly affected by the opioid epidemic. Other health care systems can learn from the agency's approach to tackling the crisis—a campaign built on education, pain management, risk mitigation, and addiction treatment.

The Department of Veterans Affairs (VA) serves a population that has been grossly affected by the opioid epidemic. Other health care systems can learn from the agency's approach to tackling the crisis—a campaign built on education, pain management, risk mitigation, and addiction treatment. Central to the educational component is academic detailing, which involves pharmacists working directly with opioid prescribers to implement best practices. They have played a pivotal role through such actions as promoting the use of naloxone and recommending alternatives to opioids. The VA's efforts toward improved pain management, meanwhile, have focused on "stepped" treatment; while risk mitigation strategies have emphasized the perils of prescribing veterans opioids in high doses, for long-term use, and/or at the same time as benzodiazepines. The VA has also successfully reached out to veterans who have developed a dependency on opioids by offering treatment via outpatient as well as inpatient settings and by linking primary and behavioral health care. A primary take-away for observers is that reducing opioid risks sometimes means curtailing overall use of the drugs but, in some circumstances, means encouraging safe consumption when they cannot be avoided. In addition, the VA's strides against opioid overuse and addiction have been aided by technology and widespread data, which allow for general best practices at the local level as well as specific solutions for outliers. Lastly, the success of VA's efforts against opioid abuse and dependence has required a commitment to significant resources, in terms of both finances and leadership.

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http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2608540

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