State Prescription Drug Monitoring Programs Need Increased Use and Oversight

Knowing a patient’s prescription history is essential to VA’s ongoing efforts to combating opioid abuse, overmedication, and deaths. The VA Office of Inspector General (OIG) conducted this audit to determine whether VA clinicians effectively used information from state-operated prescription drug monitoring programs (PDMPs) to manage and coordinate care for patients prescribed opioids. The OIG estimated that clinicians did not annually check PDMP databases for 73 percent of the 779,000 VA patients prescribed opioids between April 1, 2017, and March 31, 2018. Furthermore, VA clinicians should have considered whether 266,000 of the patients on long-term opioid therapy needed more frequent database queries. The OIG also estimated that 19 percent of VA patients prescribed opioids were at risk because VA clinicians did not perform the required query and were unaware of controlled substance prescriptions the patients may have obtained outside VA. The OIG concluded that the Veterans Health Administration (VHA) lacked effective internal controls to monitor and evaluate the performance of PDMP queries. Clinicians did not perform required queries because VHA did not effectively communicate its PDMP policy. Also, some medical facilities established less-stringent local policies, which were not reviewed to ensure they complied with VHA’s, and VHA did not address significant new developments or increased risks that affected its policy directive. Finally, the OIG found inadequate national VHA oversight and monitoring led to insufficient local monitoring and accountability at VA medical facilities. This occurred because VHA officials did not always consider PDMP queries a high priority as they implemented the Opioid Safety Initiative and focused on the reduction of VHA-issued opioid prescriptions. The OIG made eight recommendations to the under secretary for health related to strengthening VA’s policies regarding use of PDMP databases and ensuring VA leaders and clinicians understand and comply with those policies.