Veterans Affairs hospitals are taking a page from the pharmaceutical playbook — and reversing it. They've hired what are effectively 285 drug company representatives across the country, including one for every VA hospital in Tennessee and Kentucky. But instead of encouraging physicians to prescribe, they're often counseling doctors against giving their patients opioids.
"Think about what drug reps do," VA Midsouth Health Network's Mark Slagle told a group of medical professionals who gathered this week in Cool Springs to talk about "turning the tide on opioids."
The reps are trained pharmacists. But rather than just lecturing a room of physicians, or sending literature in the mail that goes straight to the recycle bin, they come by and sit in a doctor's office. Slagle says they ask about the kids or the golf game, and then they go through a slick one-on-one presentation.
This method is called "academic detailing" in the drug industry. And Slagle says that it's a proven method.
"I would ask you: Does detailing pharmaceuticals work for the pharmaceutical industry? Yes, it really does, or they wouldn't put all the money they do into it," he said.
Slagle says he's even monitoring the contacts by his counselors through software that makes sure they don't wear out their welcome. Like drug reps, he wants them to come back for follow-up visits to reinforce the cautionary message about opioids.
These calls have been cited in the Journal of the American Medical Association. And they're getting some credit for helping reduce opioid prescriptions by more than a third at VA facilities in Tennessee and Kentucky over the last three years.
"It's not about just taking away opioids. It's about not starting them in the first place," Slagle said, noting a massive culture shift at the VA.
Tennessee officials see academic detailing as a potentially broader solution to drive down opioid use in the state.
David Reagan, Tennessee's chief medical officer, says it's "ironic" that an aggressive pharmaceutical sales technique — similar to what sparked the opioid epidemic — could help dig the country out.
"What you're trying to get is the unvarnished facts that have the right context around them and have the long term interest of the patient at heart, which is the information that prescribers need to have in front of them," Reagan said. "Unfortunately, in the history of this epidemic those facts have not always been there."