BECKLEY -- Administrators at the Beckley Veterans Affairs Medical Center know their hospital prescribes powerful painkillers at some of the highest rates in the nation.
But it's not necessarily a sign the hospital is over-prescribing the medication -- or of rampant abuse of the system -- and the hospital has taken steps to address the problem in recent years, officials recently told the Daily Mail.
"We were concerned when we saw it, but we have put things in place to make sure we are providing pain medications to the veterans that need it," Director Karin McGraw said. "And for the ones that we detect that they either don't need it or they may be abusing it, we stop it."
McGraw spoke in reference to data included in a recent investigation from the Center for Investigative Reporting -- a national nonprofit journalism organization. The center found from 2001 to 2012, the per-patient prescription rate for four pain medications was the second highest of any center in the nation.
The Huntington VA placed fourth on the list.
The center looked at prescriptions for hydrocodone, oxycodone, methadone and morphine. Oxycodone and hydrocodone are found in the medications OxyContin and Vicodin, respectively.
It also found prescription rates are rising faster than the number of patients using the facilities at a national level.
The report was old information to McGraw and Dr. John Berryman, the center's chief of staff. Reports provided as early as the late 2000s by the national VA informed the center of its high per-patient prescription rates, McGraw said.
Both pointed to the aging Vietnam veterans and younger veterans with injuries "never seen before" leading to more prescriptions. McGraw also said a national initiative, known as "pain as the 5th vital sign," called on VAs to more aggressively attack pain.
Both issues face all VAs, McGraw and Berryman said.
Southern West Virginia is notorious for obesity, diabetes, smoking and lack of physical activity, all of which are reported at a local and national level. Those kinds of health problems are only amplified when a patient also happens to be a veteran, Berryman said.
"(People in the area) tend to be, in my experience and just in my opinion, more used to smoking at an early age, paying less attention to normal health measures than what we try to advocate," Berryman said.
"Their health is, generally speaking, at a lower level in terms of maintenance than patients their age in other areas or states. So they may need more narcotic use to alleviate painful symptoms," he said.
He said that's a big reason why prescription rates at the Beckley VA are so different from those at the Martinsburg VA.
Martinsburg served more than double the number of patients than Beckley but prescribed about half the number of painkillers, according to the report. The overall health of the population in Martinsburg and surrounding areas is "non-comparable," Berryman said.
Most veterans served at Beckley served in Vietnam, McGraw said. For VAs close to military installations, the number of younger veterans is significantly higher, she said.
Younger veterans have options -- weight training, physical therapy -- that might preclude them from needing painkillers, she said.
Poor health is not unique to southern West Virginia. Many VA medical centers, like Beckley, do not directly neighbor a military installation.
There is fraudulent painkiller use at Beckley, Chief of Pharmacy Brenda Rappold said. But Rappold, McGraw and Berryman are confident policies and changes implemented in recent years will help keep it to a minimum.
Addressing 'rescue medications'
After reviewing national data, the Beckley VA started to make changes in 2009.
The administration hired a pain management specialist. The VA revamped its contract with patients who have long-term narcotic prescriptions in 2009, calling for patients to abide by stricter standards.