Shulkin VA’s inroads in treatment of opioid abuse could be example for N.J., elsewhere

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When politicians like U.S. Sens. Cory Booker and Robert Menendez say the opioid abuse crisis doesn’t discriminate, they don’t just mean class or race or age.David Shulkin, undersecretary of health at the U.S. Department of Veterans Affairs, said his department has had to battle the crisis as well.

Shulkin spoke on a panel that included Booker and Menendez (both D-N.J.), as well as U.S. Surgeon General Vivek Murthy at an event focused on the opioid crisis Monday at St. Barnabas Medical Center in Livingston.

“Some wonder, ‘Why the VA? What does the VA with all its problems have to do with the addiction issue?’” Shulkin, a former president of Morristown Medical Center, said. “I will tell you, this is an area where the VA is leading American medicine.”

He added that some of the solutions the department has created to battle the addiction problem could be used by communities in New Jersey and around the country.

“Veterans have a particularly high rate of chronic pain,” he said.

National numbers are higher than in N.J., Shulkin said.

“Nationally, 12 percent of all veterans are on opioids. In N.J., 5 percent,” Shulkin said.

Other national stats include: 60 percent of all veterans returning from a recent conflict suffer from chronic pain, and 50 percent of older veterans suffer from chronic pain — that’s double the amount of the general U.S. population, Shulkin said.

So, in 2013, the VA decided it had to address the situation. Since then, it has reduced the use of opioids by the veteran population by 22 percent, Shulkin said.

That’s 151,000 veterans that have been taken off of opioids.

The VA has also reduced the dosage of opioids by 32 percent, and reduced the chronic use of opioids by 30 percent, Shulkin said.

Two specific efforts by the VA have ensured the progress in opioid reduction. First is toxin screenings to check which medications patients are on and ensure that any new prescriptions won’t create adverse reactions — but it helps to check for opioids, too — and a second is a prepaid envelope to collect old and unused pills, Shulkin said.

He credits the success of the department’s efforts on having a single electronic medical record system for the whole department and all the hospitals within, allowing them to keep better track of patients.

But when outside the system, as often happens with patients, Shulkin said, real-world problems affect vets equally.

Out in the rest of the world, the medical records are unknown and do not transfer between facilities, and the VA’s records aren’t accessible by hospitals.

Shulkin said he hopes the successful programs to battle addiction within the VA can help New Jersey’s health system, as well as others around the country.

That is apparently, increasingly, the way things are being done in Washington, D.C., he said. Federal departments are working together on issues of health rather than competing.

 “I think that what you are seeing under President (Barack) Obama’s leadership is asking that those of us who are leading federal agencies really begin to work together on important issues,” Shulkin said. “You see this with the Moonshot (cancer) initiative … and you are seeing this more and more coming out of Washington.”