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VA use of narcotic prescriptions make veterans susceptible to the nation's opiate crisis
Ain Air Force pharmacy technician separates and counts prescription medicine at Hurlburt Field, Fla., May 30, 2018. (U.S. Air Force photo by Airman 1st Class Rachel Yates)
Military personnel are tasked with some of the most physically punishing work that exists today. Whether loaded down with heavy gear in the field, getting bounced around in the belly of a heavily-armored tank, or contorting into bizarre positions to perform aircraft maintenance, we routinely suffer damage that few civilians ever will. That damage leads to pain, and that pain often leads to a prescription for opiate painkillers.
Nearly two decades of war has predictably created a lot of broken veterans. For many years, the answer was to throw opiate painkillers at the problem, but unfortunately, these narcotics cause both physical and psychological addiction when taken over an extended period of time.
Opiate painkillers work by obstructing pain receptors in the brain, spinal cord, and other areas of the body. This means that when the body sends messages of pain to the brain, those messages are blocked by the opiates and the feelings of pain will either be greatly reduced or completely unfelt. Additionally, opiates flood the brain with dopamine, which can decrease depression and induce feelings of pleasure or euphoria.
However, when you over-stimulate the brain for an extended period of time, larger dosages of opiate painkillers are necessary to achieve the same effects. This leads to addiction.
The opiate crisis began in the late 1990s when a pharmaceutical company called Purdue Pharma, based in Stamford, Connecticut, began aggressively marketing the painkilling drug OxyContin, which is derived from opiates, to doctors and other medical professionals throughout the United States. The company falsely claimed that the powerful drug was not addictive and even offered monetary incentives to doctors who prescribed the medication.
Unfortunately for the millions of people prescribed the drug, OxyContin turned out to be highly addictive, resulting in the pills being crushed and snorted, stolen from pharmacies and sold on the streets. Although in a 2007 lawsuit Purdue Pharma pleaded guilty to misleading the public about the addiction risks associated with OxyContin and agreed to pay $600 million in fines, the damage had been done.
Nationwide, the drug was taking more and more lives every year. In 2015, opiates were responsible for more than 33,000 overdose deaths. In 2017, more than 64,000 Americans were killed by drug overdoses—an overwhelming percentage coming from opiate drugs. This is higher than the number of American lives lost in the Vietnam, Iraq, and Afghanistan conflicts combined. In October of 2016, President Trump declared opiate addiction a national public health emergency.
The problem has become so widespread across such a wide range of demographics that in January of 2018, the Department of Transportation has even stepped up to update their DOT drug testing regulations to include four additional semi-synthetic opioids; hydrocodone, hydromorphone, oxymorphone, oxycodone, in addition to all previous drugs on the DOT panel, which include amphetamines, cocaine, marijuana, and PCP.
How does this affect our nation's veterans?
Recent studies have shown that nearly one out of every ten veterans suffers from chronic pain, which is classified as severe pain that occurs almost every day. This is almost forty percent higher than the number of non-veterans who complain of severe pain.
These veterans, whose ailments might range from something as mundane as back pain to something more severe, like amputated limbs, are frequently prescribed opiate painkillers, and because the pain is chronic, the prescriptions last indefinitely. It's no surprise then, that serious addictions frequently arise.
According to the Defense Department, as of September 2017, there were more than 1.3 million active duty military members and another 800,000 personnel on reserve. As of 2016, there were more than 20.4 million veterans, according to the Department of Veterans Affairs.
Once a veteran is back home, if he or she was honorably discharged and served for at least 24 consecutive months, then medical assistance is available through the Veterans Health Administration, which operates more than 150 hospitals and 1,400 outpatient clinics throughout the nation.
This may seem like a lot of facilities, but not when you factor in the more than 9 million veterans who suffer from physical or mental ailments and seek treatment through the VA every year. In fact, the system is at times so backlogged that it's not uncommon for veterans in need of prosthetics or major surgery to be waitlisted for years at a time. The result? Overmedication.
Navy veteran, Jon Spivey, who runs the Atlanta branch of national drug testing company, USA Mobile Drug Testing, explains:
"What we're seeing in the field appears to line up with the reported statistics, but what most people don't realize is the reason behind this crisis. It's not that veterans are more prone to drug abuse—they are not. It's often due to the fact that many veterans have suffered extensive physical trauma, and an overloaded VA healthcare system has simply thrown powerful and addictive narcotics at them without adequately explaining the risks."
In an attempt to combat this addictive cycle, the VA has started to follow guidelines implemented by the Centers of Disease Control and Prevention (CDC) that discourage physicians from prescribing opiate painkillers for chronic pain and encourage them to use non-opiate treatments first. Alternative treatments include over-the-counter medications such as Tylenol or Advil, as well as acupuncture or meditation therapy.
If a veteran is prescribed an opiate, the VA is encouraging physicians to cap the dosage at 50 mg or less per day. Studies have shown that when dosages are higher, in the 100 mg per day range, the chances of addiction increase drastically. This falls in line with recommendations from the CDC for physicians and medical professionals who serve the civilian community.
While these new guidelines have greatly reduced the number of opiate painkiller prescriptions issued in the veteran community in recent years, they have also lead to new crises within the veteran community, namely, the purchasing of illegal drugs on the street and suicide. Because VA hospitals and doctors have begun to aggressively limit the number of opiate painkiller prescriptions they issue, whether the patient was abusing the drug or not, many veterans are turning to the streets to find the drugs they have become accustomed to in order to numb their pain. This practice is both illegal and dangerous.
Some veterans are finding it so difficult to live without access to opiate painkillers that instead of trying other types of pain management, they are taking their own lives. Approximately twenty-two veterans commit suicide every single day in the United States. This rate is 21 percent higher than non-veteran adults.
How can the United States solve this epidemic within the veteran community?
There are several possible avenues that can help. In addition to following the guidelines recommended by the CDC, medical professionals need more education on the potential dangers of opiate prescriptions, and they need to share that information with patients to help reduce the risk of addictions or accidental overdoses.
Additionally, the VA needs to track and monitor opiate prescriptions so that patients cannot see multiple physicians for the same ailment and over-medicate. Also, in the event of an opiate overdose, both medical facilities and first responders need to be equipped with antidotes such as Narcan.
Finally, at home, just as while serving, it's our responsibility—each and every one of us—to look after our fellow veterans. In my opinion, this is no different than looking after the guys (or girls) top your left and right in a firefight. We share a bond that less than one percent of this great nation will ever understand and that bond doesn't go away once the uniform comes off.
In a perfect world, veterans suffering from chronic pain or other ailments would be able to receive the appropriate treatment in a timely manner. Until then, medical professionals must take responsibility for the treatment they can provide to help ensure that our brothers and sisters can lead happy, healthy lives when they return from serving our country.
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