Report: Prescription drugs seem to 'vanish' from VA hospitals across the country

Opioid theft, missing prescriptions or unauthorized drug use by employees have increased at Department of Veterans Affairs medical centers since 2009, according to data obtained by the Associated Press.

Federal authorities plan to increase investigations into claims that doctors, nurses and pharmacy staff at these hospitals have siphoned away controlled substances for their own use or for street sales. Drugs intended for patients have seemingly disappeared within the VA system.

According to the Associated Press, congressional auditors found that the hospitals have been lax in tracking drug supplies.

"Drug theft is an area of concern," Jeffrey Hughes, the VA's acting assistant inspector general for investigations, told the AP. He said that sometimes hospitals skip or miss inspections that are supposed to root out crime.

Both the inspector general's office and the Drug Enforcement Administration said they increased scrutiny of reported drug thefts from the VA.

Medical experts and law enforcement officials told the AP that there's a similar drug theft problem at private facilities, too, since opioid abuse is so rampant across the United States.

The VA has received particular scrutiny from lawmakers and the public, since the 2014 wait-time scandal at a VA facility in which some patients died.

"Those VA employees who are entrusted with serving our nation's wounded, ill and injured veterans must be held to a higher standard," Joe Davis, spokesman for Veterans of Foreign Wars, told the AP.

The VA did not respond to the AP's request for a list of facilities where drugs had been reported missing or disciplinary action was taken.

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What opioids do to your health

Opioid painkillers capitalize on our body's natural pain-relief system. We all have a series of naturally produced keys ("ligands") and keyholes ("receptors") that fit together to switch on our brain's natural reward system — it's the reason we feel good when we eat a good meal or have sex, for example. But opioids mimic the natural keys in our brain — yes, we all have natural opioids! When they click in, we can feel an overwhelming sense of euphoria.

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Opioid painkillers can have effects similar to heroin and morphine, especially when taken in ways other than prescribed by a doctor.

When prescription painkillers act on our brain's pleasure and reward centers, they can make us feel good. More importantly, though, they can work to reinforce behavior, which in some people can trigger a repeated desire to use.

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You may also feel sleepy.

Opioids act on multiple brain regions, but when they go to work in the locus ceruleus, a brain region involved in alertness, they can make us sleepy. Why? The drugs essentially put the brakes on the production of a chemical called norepinephrine, which plays a role in arousal.

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Your skin may feel flushed and warm.

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You'll begin to feel their effects 10 to 90 minutes after use, depending on whether they're taken as directed or used in more dangerous ways.

Some drugmakers design versions of their medications to deter abuse. Extended-release forms of oxycodone, for example, are designed to release slowly when taken as directed. But crushing, snorting, or injecting the drugs can hasten their effects.

It can also be deadly. Between 2000 and 2014, nearly half a million Americans died from overdoses involving opioid painkillers and heroin, a report from the US Centers for Disease Control and Prevention found. The most commonly prescribed painkillers were involved in more overdose deaths than any other type of the drug.

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Your breathing will slow as well.

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Depending on the method used, the effect can last anywhere from four to 12 hours.

For severe pain, doctors typically prescribe opioid painkillers like morphine for a period of four to 12 hours, according to the Mayo Clinic. Because of their risks, it's important to take prescription painkillers only according to your physician's specific instructions.

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Overdosing can stop breathing and cause brain damage, coma, or even death.

2014 report from the American Academy of Neurology estimates that more than 100,000 Americans have died from prescribed opioids since the late 1990s. Those at highest risk include people between 35 and 54, the report found, and deaths for this age group have exceeded deaths from firearms and car crashes.

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Combining them with alcohol or other drugs — even when taken according to the directions — can be especially deadly.

Since they slow breathing, combining opioid painkillers with other drugs with similar effects can drastically raise the chances of accidental overdose and death.

Yet they're often prescribed together anyway, according to the National Institute on Drug Abuse. "Unfortunately, too many patients are still co-prescribed opioid pain relievers and benzodiazepines [tranquilizers]," the institute said. In 2011, 31% of prescription opioid-related overdose deaths involved these drugs.

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Abusing opioid painkillers has been linked with abusing similar drugs, like heroin.

A CDC report found that people who'd abused opioid painkillers were 40 times as likely to abuse heroin compared with people who'd never abused them. The National Institute on Drug Abuse says that close to half of young people surveyed in three recent studies who'd injected heroin said they'd abused prescription painkillers before they started using heroin.

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You may also develop a tolerance for the drugs so that you need more to get the same effect over time.

Tolerance to opioid painkillers happens when the brain cells with opioid receptors — the keyholes where the opioids fit — become less responsive to the opioid stimulation over time. Scientists think that this may play a powerful role in addiction.

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Suddenly stopping the drugs can result in withdrawal symptoms like shakiness, vomiting, and diarrhea.

Taking prescription painkillers for an extended period increases the likelihood that your brain will adapt to them by making less of its own natural opioids. So when you stop taking the drugs, you can feel pretty miserable. For most people, this is uncomfortable but temporary.

But in people who are vulnerable to addiction, it can be dangerous because it can spurn repeated use.

"From a clinical standpoint, opioid withdrawal is one of the most powerful factors driving opioid dependence and addictive behaviors," Yale psychiatrists Thomas Kosten and Tony George write in a 2002 paper in the Journal of Addiction Science & Clinical Practice.

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Incidents of drug loss or theft at federal hospitals jumped from 272 in 2009 to 2,926 in 2015, before dipping to 2,457 last year, according to DEA data obtained by the AP.

Drug thefts from the VA raise the possibility that patients will be denied the medications they need or that they will be treated by staff members who are impaired by drugs.

A former VA employee in Baltimore pleaded guilty to charges that he injected himself with fentanyl intended for patients who were headed into surgery, then refilled the syringes with saline solution. Patients then received solution tainted with Hepatitis C virus carried by the employee, according to the AP.

Dr. Dale Klein, a VA pain management specialist, said some patients weren't getting the drugs they needed, including someone with an amputated leg who had to do without morphine because the VA pharmacy did not have enough in supply.

Klein, who is part of a whistleblowers network called VA Truth Tellers, described several of VA's inventory lists as inconsistent or a "slapdash rush job."

At the VA hospital in Washington, D.C., monthly checks were missed there more than 40 percent of the time -- specifically in the operating room and intensive care units.

According to the AP, other problems were found in VA hospitals in Seattle, Milwaukee and Memphis, Tennessee.

The House Veterans Affairs Committee planned a hearing on the inspection issue. Its chairman, Rep. Phil Roe, said failing to follow protocol "should not be tolerated within VA."

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