VA tightening rules for prescribing certain psychiatric drugs and painkillers

WASHINGTON — The Department of Veterans Affairs will strengthen rules in 2027 for clinicians prescribing certain mental health drugs and painkillers to help ensure that patients are fully informed of the benefits and risks, the agency announced.

The change will require tens of thousands of patients who use the VA health care system to have documented discussions with their providers before receiving certain prescriptions, the VA said.

Veterans also will have to provide their written consent to receive some of the more powerful prescription drugs, the VA said.

The VA already requires a veteran’s signature for long-term opioid use, which is defined as 90 or more days of treatment for noncancer pain, according to Becker’s Behavioral Health.

“Yes, some veterans may say, ‘I don’t want the prescription now,’ after their doctor goes over the risks with them. But then their provider will have to document the refusal in their records,” said Charles Garbarino, a retired Army colonel and physician.

VA clinicians already provide guidance to patients about the risks and benefits of medications.

The new rules will require veterans under the age of 30 to give their signed consent before receiving prescriptions for antidepressants, according to the VA.

Veterans of any age will have to provide signed consent before receiving concurrent prescriptions for opioids and benzodiazepines.

Opioids are classified as narcotics and include oxycodone, hydrocodone and other painkillers that are only available with a doctor’s prescription, according to the Centers for Disease Control.

Benzodiazepines reduce nervous system activity and are prescribed to reduce anxiety. They include the brand-name drugs Xanax, Valium and Ativan.

Concurrent use of opioids and benzodiazepines is associated with higher risks of dependence, overdose and death, according to the National Institutes of Health.

The VA also will include standardized patient education for any veterans prescribed psychotropic medications, including those drugs requiring only verbal consent.

Psychotropic drugs refer to a broad category of medications for treating mental health conditions, according to the NIH.

As a former combat physician who gets his health care through the VA, Garbarino said that prioritizing discussions between VA providers and patients should make it easier for veterans to learn about drugs and ask questions before filling prescriptions.

Garbarino also said that doctors in both the public and private sectors typically do not explain in detail potential side effects, which most often are printed or can be scanned with a QR code when the pharmacy fills the order.

“No one discusses all the side effects. I’m talking about all physicians,” Garbarino said.

The VA plans to use the next 90 days to educate and train staff about the new rules and guidance for prescribing psychiatric drugs, which will become effective in 2027, the VA said.

“America’s veterans should get as much information as possible as they are deciding what treatment is best for them,” VA Secretary Doug Collins said, when the VA announced the policy changes on Monday.

The VA issued more than three million opioid prescriptions to approximately 577,000 veterans in fiscal year 2021, according to Disabled American Veterans.

Veterans are twice as likely to experience a fatal opioid overdose compared to the general population, according to the NIH.

Garbarino also cautioned that patients experiencing chronic pain or serious mental illness may be overwhelmed by a flood of written information about the drugs they are prescribed.

“When my VA doctor or psychiatrist says this is the medication that will help with your mood disorder, my answer is OK,” said Garbarino, who has PTSD, nightmares and anxiety connected to three tours of duty in Iraq.

“I get the standard printed educational materials with my medication from the pharmacy. Do you think I read it? Never.”