Sec. 251. 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 developed by the Centers for Disease Control and Prevention for safely prescribing opioids for the treatment of chronic, noncancer related pain in outpatient settings. Enhanced guidance with respect to absolute contraindications for opioid therapy, including guidance with respect to the following:
The coadministration of drugs, including benzodiazepines, that are capable of inducing a life-limiting drug-drug interaction. 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 and improving function; and whether opioid therapy should be continued. Requirements that each health care provider of the Department of Veterans Affairs, before initiating opioid therapy to treat a patient, use the Opioid Therapy Risk Report tool of the Department, including by accessing the most recent patient information from the prescription drug monitoring program of each State, as required to be included in such tool under section 252(d)(1), 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 inform the methodologies used by health care providers of the Department of Veterans Affairs and the Department of Defense to safely titrate and taper opioid therapy when adjusting or discontinuing the use of opioid therapy, including— prescription of the lowest effective dose 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. 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— that such tests should occur not less frequently than annually or as otherwise determined according to patient treatment protocols; and that health care providers should 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. Nothing in this subsection shall be construed to prevent the Secretary of Veterans Affairs and the Secretary of Defense from considering all relevant evidence, as appropriate, in updating the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, as required under paragraph (1), or from ensuring that the final clinical practice guideline updated under such paragraph remains applicable to the patient populations of the Department of Veterans Affairs and the Department of Defense.
Before updating the clinical practice guideline under subsection (a), the Secretary of Veterans Affairs and the Secretary of Defense shall jointly consult with the Pain Management Working Group of the Health Executive Committee of the Department of Veterans Affairs-Department of Defense Joint Executive Committee established under section 320 of title 38, United States Code. 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. 251
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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