Sec. 101. Guidelines on management of opioid therapy by Department of Veterans Affairs and Department of Defense and implementation of such guidelines by Department of Veterans Affairs
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Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs and the Secretary of Defense shall jointly update the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain to include the following: Guidelines for safely prescribing opioids for the treatment of chronic, non-cancer pain in outpatient settings as developed and released by the Centers for Disease Control and Prevention. Enhanced guidance with respect to absolute contraindications for opioid therapy, including guidance with respect to the following:
The coadministration of drugs that are capable of inducing a life-limiting drug-drug interaction, including benzodiazepines. The treatment of patients with current acute psychiatric instability or substance use disorder or patients at risk of suicide. The use of opioid therapy to treat patients without any pain, including to treat mental health disorders other than opioid use disorder. Enhanced guidance with respect to the treatment of patients with behaviors or comorbidities, such as post-traumatic stress disorder, psychiatric disorders, or a history of substance abuse or addiction, that require consultation or comanagement of opioid therapy with one or more specialists in pain management, mental health, or addictions.
Enhanced guidance with respect to the conduct by health care providers of an effectiveness assessment for patients receiving opioid therapy, including patients on long-term opioid therapy, to determine— whether opioid therapy is meeting the expected goals of the patient and health care provider of relieving pain, improving function, and providing patient satisfaction; and whether opioid therapy should be continued. Requirements that each health care provider of the Department of Veterans Affairs and the Department of Defense, before initiating opioid therapy to treat a patient, use the Opioid Therapy Risk Report tool of the Department of Veterans Affairs, including information from the prescription drug monitoring program of each State that includes the most recent date information relating to the patient was accessed through such program, as required to be included in such tool under section 102(d)(2), to assess the risk for adverse outcomes of opioid therapy for the patient, including the concurrent use of controlled substances such as benzodiazepines, as part of the comprehensive assessment conducted by the health care provider.
Guidelines to govern the methodologies used by health care providers of the Department of Veterans Affairs and the Department of Defense to taper opioid therapy when adjusting or discontinuing the use of opioid therapy. Guidelines with respect to appropriate case management for patients receiving opioid therapy who transition between inpatient and outpatient health care settings, which may include the use of care transition plans. Enhanced recommendations with respect to the use of routine and random urine drug tests for all patients before and during opioid therapy to help prevent substance abuse, dependence, and diversion, including requirements— that such tests occur not less frequently than once each year; and that health care providers appropriately interpret and respond to the results from such tests to tailor pain therapy, safeguards, and risk management strategies to each patient.
Guidance that health care providers discuss with patients, before initiating opioid therapy, options for pain management therapies without the use of opioids and options to augment opioid therapy with other clinical and complementary and integrative health services to minimize opioid dependence. Before updating the guideline under subsection (a), the Secretary of Veterans Affairs and the Secretary of Defense shall jointly consult with the working group on pain management and opioid therapy established in section 103.
Not later than one year after the Secretary of Veterans Affairs updates the guideline under subsection (a), and not less frequently than annually thereafter, the Comptroller General of the United States shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on— the implementation by each medical facility of the Department of Veterans Affairs of such guideline; and the compliance by each such medical facility with such guideline.
In this section, the term controlled substance has the meaning given that term in section 102 of the Controlled Substances Act ( 21 U.S.C. 802 ).
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Sec. 101
Guidelines on management of opioid therapy by Department of Veterans Affairs and Department of Defense and implementation of such guidelines by Department of Veterans Affairs
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