Veteran Informed Prisons: A Guide to Improving the Health and Well-being of Prisoners in Wales who are Veterans
Abstract: ‘Veteran Informed Prisons: A guide to improving the health and well-being of prisoners in Wales who are veterans’ is intended to support commissioners, planners and staff across health and prison services in Wales. It has been produced by a Task & Finish Group (see Annex E) comprising representatives of the Welsh Government, NHS Wales, the National Offender Management Service (NOMS), prison staff, the Ministry of Defence (MoD) and third sector support organisations for ex-service personnel. All share a common interest: to ensure that prisoners in Wales who are veterans of the Armed Forces have their health and welfare needs met.
Abstract: Context: In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Objective: Examine temporal trends in opioid prescribing, pain, and opioid overdoses among Veterans near the end of life. Methods: Retrospective, time series analysis of VA decedents between October 2009 and September 2018 whose next-of-kin participated in VA's Bereaved Family Survey (BFS). Using multivariate regression to adjust for sociodemographic and clinical covariates, we examined temporal trends in outpatient opioid prescribing, uncontrolled pain based on BFS report, and opioid overdose-related hospitalizations, in the last month of life, overall and by clinical diagnosis (cancer versus non-cancer). Results: Among 79,409 decedents, mean daily outpatient opioid dose in morphine milligram equivalents in the last month of life decreased from 4.6 mg in 2010 to 2.1 mg in 2018 (adjusted change -0.20 mg/year; P