Assessing and improving the government’s response to the veterans’ opioid crisis

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Editor's note:

This paper comes from the paper series “The opioid crisis in America: Domestic and international dimensions.”

Executive summary

Over the past two decades, opioid use and abuse have created a public health emergency in the United States. As hundreds of thousands of Americans have died from accidental overdoses or suicide, public health and elected officials have sought policy solutions. With the goals of reducing opioid-related deaths, overprescribing, and opioid use disorder (OUD), state and federal policymakers have enacted policies to improve funding, expand research, identify and expand best practices, and investigate the causes of the current crisis.

As part of the significant attention paid to this issue, policymakers often identify groups that are especially vulnerable to OUD. Among those vulnerable groups are veterans. By virtue of service to our country, especially in a period of ongoing war, veterans report higher rates of severe pain and chronic pain than the general population. Those realities create an environment where opioid therapies can become widespread and lasting. For veterans who are also disproportionately likely to experience mental health conditions such as posttraumatic stress disorder (PTSD), opioid use can present additional challenges such as dependence.

While combatting the opioid crisis requires federal, state, local, and private efforts, the veterans’ population presents a unique opportunity for federal policymakers to play an outsized role. Although it should be noted that state, local, and private actors also play important roles in helping veterans deal with OUD and aid in the prevention of opioid misuse. However, more than 9 million veterans are enrolled in the Veterans Affairs (VA) health care program, accessing more than 1,200 facilities in all 50 states, Washington, D.C., and territories. This allows the federal government to enact changes to health care programming that can have a direct impact on a significant percentage of veterans.

This paper will offer a policy analysis and status update on the opioid crisis among veterans. It will proceed in four parts. First, it will describe the scope and depth of the opioid crisis among the veteran population, with key attention paid to the unique risks that the veterans’ experiences pose. This section also highlights some of the challenges VA has faced in addressing this crisis among its patient population. Second, it will review the major legislative achievements over the past five years that address the opioid crisis, with attention paid to the extent to which veterans’ issues were dealt with directly. Third, it will review the responses by VA and other federal departments and agencies to address opioid use disorder and opioid related deaths among veterans. This section will also focus on agencies’ responsiveness to legislative mandates from Congress. Fourth, it will look ahead to additional changes that can be enacted to assist veterans dealing with OUD and to improve the ability of VA to reform to meet the needs of the opioid crisis.

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