George Mason University Antonin Scalia Law School

The U.S. Department of Veterans Affairs’s Fight Against the Opioid Epidemic and Non-opioid Treatment Alternatives for Servicemembers and Veterans.

Written By Spring 2024 M-VETS Student Advisor Andrew Yildizlar.

The Opioid Epidemic

The opioid epidemic has harmed the lives of far too many servicemembers, veterans, and their family members. Opioid synthetic drugs are pain relievers which, if used incorrectly at high doses, can slow breathing to the point of death.[1] Opioid Use Disorder (OUD) is a chronic disorder that involves the problematic overuse or otherwise misuse of opioids.[2] The VA’s diagnoses of veterans with OUD have risen from 25,031 in 2003 to 69,142 in 2017.[3] On October 26, 2017, the Acting Secretary of the Department of Health and Human Services declared the opioid crisis a public health emergency.[4] In 2020, opioids caused nearly seventy-five percent of all drug overdoses in the U.S.[5] Veterans have and continue to suffer from the opioid crisis, with over a fifty percent increase in overdose mortality rates between 2010 and 2019.[6] In fact, veteran patients of the U.S. Department of Veterans Affairs (VA) have a higher risk of overdose and death compared to the general population.[7] The opioid crisis is therefore a real and pervasive issue that demands a resolution, particularly for vulnerable veterans injured in service.

The U.S. Department of Veterans Affairs’s Response

In response to the opioid epidemic, the VA has initiated non-opioid treatment options and a plan to reduce opioid prescriptions.[8] In 2013, the VA developed the Opioid Safety Initiative (OSI) to minimize harm to VA patients. The OSI consists of guidelines for Department of Defense and VA Health Care practitioners that specify when the use of opioids is recommended for patients based on current information and practices.[9] Through the OSI, the VA has worked to lower the likelihood that a veteran develops OUD by restricting practitioners’ opioid prescriptions to only those severe cases.[10] The OSI has gradually reduced opioid prescriptions each year. In 2023, the VA announced that it reduced opioid prescriptions for veterans by sixty-seven percent, from 874,897 prescriptions in 2012 to 288,820 in 2023.[11] Since 2020, the VA has reduced opioid prescriptions by sixteen percent, from 345,910 prescriptions to 288,820.[12]

In part, the VA has accomplished a reduction in prescriptions by increasing access to tested therapies and other treatments in lieu of opioids.[13] For example, the VA instituted a multifaceted treatment plan under the “Whole Health” approach.[14] Under this model, the VA Medical Centers offer both “conventional clinical care (such as medicines or counseling) and complementary and integrative care (such as acupuncture or yoga).”[15] If a veteran is interested in learning about starting a personalized health plan under the Whole Health service, more information can be found at

Furthermore, the VA has found that non-drug therapies can “reduce the risk of adverse outcomes like substance use disorders and suicide attempts later in life.”[16] In one study conducted in 2020 at the VA Palo Alto Health Care System, “veterans who received non-drug therapies like acupuncture, biofeedback, or chiropractic care during their service had a significantly lower risk of new-onset alcohol or drug use disorders; poisoning with opioids, barbiturates, or sedatives; and suicidal thoughts and attempts while under VA care.”[17] Thus, the VA has recognized the need to move away from opioid use when other pain management treatments are viable.

The Senators’ Letter to the VA

On April 16, 2024, U.S. Senators, including Kevin Cramer (R-ND), Jeanne Shaheen (D-NH), Shelley Moore Capito (R-WV), Tammy Baldwin (D-WI), and Mike Braun (R-IN), wrote a letter to VA Secretary Denis McDonough asking the VA to “share the progress it has made in incentivizing the use of non-opioid pain management options to prevent addiction within the veteran community.”[18]

In the letter, the Senators explained that “active-duty service members, veterans, retirees and their families are not immune to the opioid addiction crisis. Nearly half of combat wounded veterans report misuse of prescription opioids. Drug overdose mortality rates among veterans also increased by 53% from 2010–2019. Therefore, it is even more important to protect veterans from unnecessary exposure to prescription opioids.”[19] The Senators further pointed out that “[o]ne critical tool to prevent opioid addiction before it starts is to incentivize the use of VA approved non-opioid pain management options, including drugs and devices. In recent years, Congress has prioritized efforts to increase access to these treatments, most recently in Medicare.”[20]

Lastly, to better understand how Congress may improve the VA’s efforts, the Senators asked the following four questions:

  1. “How many non-opioid pain alternatives are currently included in the VA National Formulary (VANF)?
  1. How frequently are non-opioid alternatives utilized in the VA system compared to opioid treatments for acute pain? Please provide any national-level data available on dispensing and usage of non-opioid pain alternatives to treat acute pain in the VA facilities and community care sites.
  1. What steps has the VA already taken to transition from opioid analgesics to non-opioid pain alternatives to treat acute pain? Please also provide a summary of your ability to consider immediate action to add safe, effective non-opioid drugs to the VANF.
  1. What steps can Congress take to facilitate these efforts?”[21]


Unfortunately, the opioid epidemic continues to affect servicemembers, veterans, and their family members. The VA has responded by implementing safer practices and treatments which have reduced opioid prescriptions for veterans under VA care. However, as Congress recognizes, there is still more to be done in the fight against OUD and misuse of opioids. Servicemembers and veterans deserve treatment of their injuries sustained while serving their country, not a temporary pain reliever that may cause unwarranted consequences as severe as death.

[1] Donald Egan, M.D., et al., Opioid Use Disorder, American Psychiatric Association (December 2022),

[2] Id.

[3] Gordon AJ, Trafton JA, Saxon AJ, et al. and Buprenorphine Work Group of the Substance Use Disorders Quality Enhancement Research Initiative. Implementation of buprenorphine in the Veterans Health Administration: Results of the first 3 yearsDrug Alcohol Depend. 2007;90(2):292–296. doi: 10.1016/j.drugalcdep.2007.03.010.

[4] Opioid Crisis: Status of Public Health Emergency Authorities, GAO U.S. Government Accountability Office (Sept. 26, 2018),,has%20been%20made%20for%20opioids.

[5] Drug Overdose Deaths, Centers for Disease Control and Prevention (Aug. 22, 2023),

[6] Begley MR, Ravindran C, Peltzman T, et al., Veteran drug overdose mortality, 2010–2019. Drug Alcohol Depend. 2022;233:109296.

[7] Bohnert AS, Valenstein M, Bair MJ, et al., Association between opioid prescribing patterns and opioid overdose-related deathsJama. 2011;305(13):1315–1321. doi: 10.1001/jama.2011.370.

[8] Kevin Cramer, U.S. Senator for North Dakota, Letter to VA Secretary Requests Update on Non-Opioid Pain Management Options for Veterans (Apr. 18, 2024),,prescriptions%20by%2067%25%20since%202012.

[9] VA reduces number of Veterans prescribed opioids by 67% since 2012, VA News (Sept. 21, 2023),,class%20pain%20management%20to%20Veterans.

[10] Id.

[11] Id.

[12] Id.

[13] Id.

[14] Veterans with chronic pain are replacing opioid pain medications, VA News (Apr. 15, 2021),

[15] Id.

[16] VA Research on Pain Management, VA Office of Research & Development,,attempts%20while%20under%20VA%20care.

[17] Id.

[18] Kevin Cramer, U.S. Senator for North Dakota, Letter to VA Secretary Requests Update on Non-Opioid Pain Management Options for Veterans (Apr. 18, 2024),,prescriptions%20by%2067%25%20since%202012.

[19] Jeanne Shaheen, United States Senator, et al., VA Non-Opioid Pain Management Letter (Apr. 16, 2024),

[20] Id.

[21] Id.