Patients were routinely overprescribed opioids at three military hospitals under a system that failed to follow medical guidelines, according to a scathing report from the Defense Department's Inspector General.
The IG's audit found that the three hospitals "overprescribed opioids between 2015 and 2017 because policies and processes were not in place to properly monitor and identify" patients receiving more than the federally recommended dose of 90 milligrams of morphine equivalent (MME) daily.
The result was that one patient, or "beneficiary," at Joint Base Elmendorf-Richardson, Alaska, received 2,450 oxycodone tablets over the course of a year, while another was prescribed 4,700 oxycodone tablets over two years, the audit said.
The audit also found that shoddy bookkeeping practices at JBER; Madigan Medical Center at Joint Base Lewis-McChord, Washington; and Naval Medical Center Portsmouth, Virginia, made it impossible to gauge the scope of the overprescribing.
"These errors prevented us from being able to determine the full universe of beneficiaries who were prescribed opioids above the recommended dose of 90 MME," the audit states.
In addition, the "professional courtesy" shown by doctors to each other often served to let glaring instances of overprescribing go unnoticed, it adds.
The report cites an unnamed doctor who "stated that it was a professional courtesy among physicians not to criticize how other physicians provided services and prescriptions to their beneficiaries."
At one of the three hospitals visited by IG teams, a pharmacist stated that "there is not a will" to stop some patients from receiving too many opioids, the audit found.
The report cites Centers for Disease Control and Prevention (CDC) guidelines and the Department of Veterans Affairs' "Clinical Practice Guideline for Opioid Therapy for Chronic Pain" as recommending "against prescribing opioid doses over 90 MME per day to treat chronic pain."
The IG's report does not attribute any deaths or suicides at the three hospitals to overprescribing but cites a Veterans Health Administration study, which concluded that "those who died of opioid overdoses were prescribed an average of 98 MME per day, while others who did not die from opioid overdose were prescribed an average of 48 MME per day."
In the existing system, DoD beneficiaries -- active-duty service members, retirees and eligible family members -- can receive health care at military hospitals and clinics, also known as Military Treatment Facilities (MTFs), on military installations worldwide.
Under the National Defense Authorization Act of 2017, the Defense Health Agency (DHA) and the surgeons general of the service branches are charged with overseeing the MTFs, the audit states.
However, the DHA and the surgeons general "did not identify and monitor those beneficiaries prescribed over 90 MME per day from 2015 to 2017," the audit found.
"For example, one beneficiary received an average of 450 MME per day for 16 months, which is five times the CDC recommended maximum dose of 90 MME that chronic pain beneficiaries should avoid," the audit states.
The report recommends that the DHA "monitor MME doses per day by beneficiary, examine data for unusually high opioid prescriptions, and if appropriate, hold providers accountable for overprescribing opioids."
The DHA agreed with the recommendation, adding that "it has already implemented solutions to the findings in the report."
-- Richard Sisk can be reached at Richard.Sisk@Military.com.