Sec. 102. Improvement of opioid safety measures by Department of Veterans Affairs
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Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall expand the Opioid Safety Initiative of the Department of Veterans Affairs to include all medical facilities of the Department. In carrying out the Opioid Safety Initiative of the Department, the Secretary shall require all employees of the Department responsible for prescribing opioids to receive education and training described in paragraph
(2)in order to appropriately implement and comply with the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, including any updates to such guideline. Education and training described in this paragraph is education and training on pain management and safe opioid prescribing practices for purposes of safely and effectively managing patients with chronic pain and includes education and training on the following: The safe and effective use of opioid therapy to treat chronic pain that is non-cancer related. The use of evidence-based pain management therapies, including cognitive-behavioral therapy, non-opioid alternatives, and non-drug approaches to managing pain and related health conditions including complementary and integrative health services. Screening and identification of patients with substance use disorder, including drug-seeking behavior, before prescribing opioids, assessment of the risk potential for patients developing an addiction, and referral of patients to appropriate addiction treatment professionals if addiction is identified or strongly suspected. The safe and effective use of urine drug tests. Prescription of the lowest effective dose of opioids based on patient need, use of opioids only for a limited period of time, and augmentation of opioid therapy with other pain management therapies and modalities. The use of safe and effective tapering programs for patients taking opioids and other controlled substances, such as benzodiazepines, concurrently and patients taking high-risk opioids. Communication with patients on the potential harm associated with the use of opioids and other controlled substances, including the need to safely store and dispose of supplies relating to the use of opioids and other controlled substances. Such other education and training as the Secretary considers appropriate to ensure that veterans receive safe, high-quality pain management care from the Department. In providing education and training described in paragraph (2), the Secretary shall use the Interdisciplinary Chronic Pain Management Training Team Program of the Department. In carrying out the Opioid Safety Initiative of the Department, each medical facility of the Department shall identify and designate a pain management team of health care professionals responsible for coordinating and overseeing therapy at such facility for patients experiencing acute and chronic pain that is non-cancer related. The director of each Veterans Integrated Service Network shall establish protocols for the designation of pain management teams at each medical facility within that Veterans Integrated Service Network. Each protocol established for a medical facility under subparagraph
(A)shall ensure that any health care provider without expertise in prescribing analgesics or who has not completed the education and training under subsection (b), such as a mental health care provider, does not prescribe opioids to a patient unless that health care provider— consults with a health care provider with pain management expertise or who is on the pain management team of the medical facility; and refers the patient to that pain management team for any subsequent prescriptions and related therapy. Not later than one year after the date of the enactment of this Act, the head of each medical facility of the Department shall submit to the director of the Veterans Integrated Service Network in which the medical facility is located a report identifying the health care professionals that have been designated as members of the pain management team at the medical facility. Each report submitted under subparagraph
(A)with respect to a medical facility of the Department shall include— a certification as to whether all members of the pain management team at the medical facility have completed the education and training required under subsection (b); and a plan for the management and referral of patients to such pain management team if health care providers without expertise in prescribing analgesics prescribe opioid medications to treat acute and chronic pain that is non-cancer related. Not later than 18 months after the date of the enactment of this Act, in carrying out the Opioid Safety Initiative and the Opioid Therapy Risk Report tool of the Department, the Secretary shall, through the Computerized Patient Record System of the Department, allow for real-time tracking of and access to data on— the key clinical indicators with respect to the totality of opioid use by veterans; concurrent prescribing by health care providers of the Department of opioids in different health care settings, include data on concurrent prescribing of opioids to treat mental health disorders other than opioid use disorder; and mail-order prescriptions of opioids prescribed to veterans under the laws administered by the Secretary. In carrying out the Opioid Safety Initiative and the Opioid Therapy Risk Report tool of the Department, the Secretary shall— ensure access by health care providers of the Department to information on controlled substances, including opioids and benzodiazepines, prescribed to veterans who receive care outside the Department through the prescription drug monitoring program of each State, including by seeking to enter into memoranda of understanding with States to allow such access; include such information in the Opioid Therapy Risk Report; and require health care providers of the Department to submit to the prescription drug monitoring program of each State information on prescriptions of controlled substances received by veterans in that State under the laws administered by the Secretary. Not later than 180 days after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the progress of the Department in implementing the improvements to the Opioid Therapy Risk Report tool of the Department required under paragraphs
(1)and (2). The Secretary shall increase the availability of opioid receptor antagonists approved by the Food and Drug Administration, such as naloxone, to veterans and increase the availability of opioid receptor antagonists for use by health care providers of the Department in treating veterans. In carrying out subparagraph (A), the Secretary shall, not later than 90 days after the date of the enactment of this Act— equip each medical facility of the Department with opioid receptor antagonists approved by the Food and Drug Administration; enhance training for health care providers of the Department on distributing such opioid receptor antagonists; and expand the Overdose Education and Naloxone Distribution program of the Department to ensure that all veterans in receipt of health care under the laws administered by the Secretary who are at risk of opioid overdose have access to such opioid receptor antagonists and training on the proper administration of such opioid receptor antagonists. For purposes of subparagraph (B), veterans who are at risk of opioid overdose include— veterans receiving long-term opioid therapy; veterans receiving opioid therapy who have a history of substance use disorder or prior instances of overdose; and veterans who are at risk as determined by a health care provider who is treating the veteran. Not later than 120 days after the date of the enactment of this Act, the Secretary 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 compliance with paragraph
(1)that includes an assessment of the following: Whether all medical facilities of the Department are equipped with opioid receptor antagonists approved by the Food and Drug Administration. The progress of the Department in ensuring that any such facilities that are not equipped with such opioid receptor antagonists obtain such opioid receptor antagonists. Whether all veterans at risk of opioid overdose have access to such opioid receptor antagonists and training on the proper administration of such opioid receptor antagonists. The progress of the Department in ensuring that all veterans at risk of opioid overdose have access to such opioid receptor antagonists and training on the proper administration of such opioid receptor antagonists. The Secretary shall include in the Opioid Therapy Risk Report tool of the Department— information on the most recent time the tool was accessed by a health care provider of the Department with respect to each veteran; and information on the results of the most recent urine drug test for each veteran. The Secretary shall include in the Opioid Therapy Risk Report tool the ability of health care providers of the Department to determine whether a health care provider of the Department prescribed opioids to a veteran without checking the information in the tool with respect to the veteran. The Secretary shall modify the Computerized Patient Record System of the Department to ensure that any health care provider that accesses the record of a veteran, regardless of the reason the veteran seeks care from the health care provider, will be immediately notified whether the veteran— is receiving opioid therapy and has a history of substance use disorder or prior instances of overdose; has a history of opioid abuse; or is at risk of becoming an opioid abuser as determined by a health care provider who is treating the veteran. 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. 102
Improvement of opioid safety measures by Department of Veterans Affairs
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