Research in the VHA showed that in a 4-year period of study, “the risk of overdose deaths was directly related to the maximum prescribed daily dose of opioid medication.” 2 A second article reviews the distribution of naloxone at a VA facility, providing an example of a successful implementation of the VA Overdose Education and Naloxone Distribution network (OEND)-the only national naloxone program in any health care system.Įven farther upstream in the effort to reduce the large doses of opioids that are directly related to overdose deaths is an article on an outpatient opioid-monitoring clinic that uses evidence-based medicine to diagnose patients with opioid use disorder. Pharmacists at the Salt Lake City VAMC studied the epidemiology of veterans seen in emergency departments who were given naloxone for unintentional opioid overdoses. Prescription opioids are the subject of 3 articles from VA practitioners: a look at primary, secondary, and tertiary forms of prevention of morbidity and mortality from substance use. We see this need reflected in this issue’s articles authored by clinical pharmacists, nurse practitioners, physicians, and physicians in training, among others. All of medicine is becoming more interdisciplinary, multidisciplinary, and team-based, but perhaps no other area has as long a legacy or as intrinsic a need for team approaches to care than does the diagnosis and treatment of SUDs. Reflecting this ubiquity, in this special substance use disorders issue of Federal Practitioner we focus on several distinctive and significant efforts of health care practitioners who care for patients with SUDs. Substance use disorders affect every sector of federal health care practice from military pediatrics and VA pathology to PHS primary care. In 2013 the National Institute on Drug Abuse reported that “members of the armed forces are not immune to the substance use problems that affect the rest of society.” 1 Although active-duty service members use illicit drugs less frequently, as would be expected given the potential disciplinary consequences, the prevalence of problematic use of the legal ones-tobacco, alcohol, and particularly prescription medications- is greater among individuals in the military. And although I did not conduct a poll or hold a debate, I suspect that a majority of those who work in the VA, DoD, or PHS would agree that one of the most serious and prevalent public health problems facing those in federal service and in the country at large is the epidemic of substance use disorders (SUDs). Given the recently concluded election season, it may seem that there are few things Americans have in common or can agree on.
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