Veterans Affairs Opioid Safety Initiative

An intervention aimed at high-dose opioid prescribing among veterans through guidelines, identifying risk factors, and risk mitigation strategies 

The Veterans Affairs developed the Opioid Safety Initiative (OSI) in 2013 as a nationwide intervention with the purpose of decreasing high-risk opioid prescribing practices, including prescribing of high-dose opioids, in a population that is disproportionately impacted by chronic pain. Some of the OSI's goals include:

  • Increasing the use of risk mitigation strategies, like urine drug screening
  • Identify and intervene on patients that are using both prescription opioids and benzodiazepines
  • Offer evidence-based alternatives to prescription opioids for chronic pain 
  • Use tools, such as prescription drug monitoring programs (PDMPs), to identify patients at high risk for overdose

One of the tools that OSI uses is the clincal practice guidelines for providers. The OSI Toolkit provides documents and presentations for clinical teams treating veterans with chronic pain. Online academic detailing tools are made available to providers.The program has evolved over time to include overdose education and naloxone education, providing integrated mental health care, and identifying patients at risk for suicide. 

The OSI has shown evidence in reducing opioid prescribing across a wide range of settings in the healthcare system. The OSI pocket card for clinicians can be found here and a presentation with more information on the program can be found here

Implementation of this quality improvement program has reduced opioid prescribing in many different healthcare settings. 

Continuum of Care
Type of Evidence
Response Approach
Cautious Opioid Prescribing
Early Intervention
Overdose prevention
Peer-reviewed Article

Evidence of Program Effectiveness

The Opioid Safety Initiative has shown positive results in reducing opioid prescribing after implementation throughout the healthcare system including: