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Complex presentation a challenge for treating veterans

August 8, 2017
by Tom Valentino, Senior Editor
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A study conducted recently by Cigna Healthcare finds a majority of practitioners believe treating veterans with opioid use disorders (OUD) is more difficult than treating those in the civilian population with OUD, and many practitioners say they aren’t adequately equipped for the challenge. The survey was conducted with all types of practitioners, not only behavioral health providers. Cigna says 99% of respondents had treated patients either taking opioids or had been diagnosed with an opioid use disorder, and 70% of the responding practitioners had treated veterans.

Of all the practitioners polled by Cigna, 72% say treating veterans is more difficult. The unique experiences of veterans make for a more complex presentation, says William Lopez, MD, CPE, senior medical director of behavioral health at Cigna.

“Veterans may have injuries from war with chronic pain or some other injuries,” says Lopez, who served as a captain in the U.S. Air Force and is a veteran of operations Desert Storm and Desert Shield. “They experience symptoms of PTSD, depression and anxiety that may affect their ability to access services. It’s a multifactorial issue that may lead to difficulty treating veterans in the community.”

To that end, more than a third of practitioners say they’re not confident they have the right resources and training to treat veterans with OUD.

“When you look outside the Veterans Administration system and you have providers in the community, they may not feel they have the resources to manage patients with complicated medical conditions, chronic pain and mental health issues like PTSD from combat,” Lopez says.

Having access to more medical support staff with extensive experience treating veterans would be most helpful, according 60% of practitioners surveyed.

Other findings

On the whole, practitioners are more confident than Americans in general that opioid use disorders can be effectively treated, as 70% of practitioners say OUDs are treatable vs. just 47% of Americans, regardless of whether they have personal experience with opioid use disorder.

Also, 43% of practitioners say overprescribing is a cause of opioid use disorders, but when treating patients, 58% say they focus more on the condition necessitating the use of a prescription opioid, such as chronic pain or an injury, than on the potential for misuse of the prescribed drug.

“Practitioners are managing what they know,” Lopez says. “They are treating the condition they understand. ‘I can help them with this. I’m not sure about the addiction piece, but let me help them with what they’re doing.’

“We need to address education, make sure they have enough resources, and provide training for their staff so they feel confident about managing a patient with complicated mental health issues like PTSD at their offices.”