Abstract: Lord Ashcroft KCMG PC was appointed the Prime Minister's Special Representative on Veterans' Transition in September 2012. He conducted a comprehensive, independent review on the process of leaving the Armed Forces and returning to civilian life; his report, The Veterans' Transition Review, was published in February 2014. Lord Ashcroft monitored progress on the implementation of his recommendations in three annual follow-up reports. He stepped down from the role in May 2018. The initial Review, follow-up reports and associated documents are available to read on this site.
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