Ricky Green was 43 when he accidentally overdosed on pain medication for a lingering back injury from the first Gulf War. He died in his sleep in September 2011. Just a month earlier, he had asked his Veterans Affairs doctors to decrease the dose of three painkillers he was taking, but the physicians told him to stay on the meds as prescribed, his wife Kimberly told CBS News. Green's death is just one example of a disturbing trend in veteran health care.
The West has 4.4 million war veterans. California alone has 1.3 million; Wyoming, Colorado, New Mexico, Montana and Washington historically have some of the highest numbers of armed service members per capita. Now, a new report shows that injured vets are being treated with addictive pain medication at an alarming rate.
The Berkeley-based Center for Investigative Reporting (CIR) recently published data that showed the number of prescriptions for powerful opiate painkillers from Veterans Affairs providers has skyrocketed – a 270 percent increase since 9/11 (while the patient population has only gone up about 29 percent). New treatments, as well as improvements in combat armor, allow soldiers to survive increasingly traumatic injuries that often lead to a greater requirement for medications to deal with the pain. (The use of opiate medications has been on the rise among civilians as well, for different reasons.) This trend corresponds with a rise in painkiller addictions and fatal overdoses among veterans at twice the national average.
The Veterans Affairs hospital in Roseburg, Ore. dispenses the nation's fifth-highest rate of prescriptions for morphine, methadone, hydrocodone and oxyocodone: 139 per 100 patients. The Rocky Mountain West has seen a 293 percent increase in VA opiate prescriptions between 2001 and 2012, with only a 37 percent rise in the number of patients. The Southwest VA hospital network’s opiate prescriptions have gone up 211 percent. VA systems in Spokane, Wash., Reno, Nev., and Portland, Ore. are also in the top ten in the country for ratio of painkiller prescriptions per patient.
Patient advocates say that the trend toward more prescriptions leaves veterans with treatment that harms them more than it helps get to the root of their pain.
“Keeping our men and woman doped up to keep them quiet and happy is not treatment. It is cruelty and torture and, in too many cases, it's manslaughter,” Heather McDonald, the widow of a veteran who died of what she thinks was an overdose, testified at a House Committee on Veterans’ Affairs hearing last week. Along with a second widow and two veterans currently struggling with pain from injuries – one of whom is on 13 medications – spoke against the culture of increasing opiate medication in response to chronic physical pain.
Senior VA officials declined to speak on the record with the Center for Investigative Reporting about the prescriptions trend. The agency did tell CIR that it’s working on “multiple ongoing efforts to address prescription drug abuse among veterans seen in our healthcare system.”
Part of the problem is a lack of coordination between doctors, which can sometimes leave patients with multiple pain medications that become a toxic cocktail when taken together in high doses. CBS reports that just two VA pain medication specialists exist to serve the needs of every 100,000 patients.
Also, in many cases, veterans are using the opiates prescribed for physical injury to self-medicate for emotional troubles such as Post Traumatic Stress Disorder (PTSD). Recent studies have found that service members are twice as likely to abuse medication than other patients. To make matters worse, PTSD itself can also make physical pain of lingering injuries even more intense, which then leads to further use of pain medication.
“It’s a vicious cycle,” Dr. Karen Seal, director of a clinic at the San Francisco Veterans Affairs Medical Center told the New York Times last year. “When you have an anxiety disorder, when you feel pain, you become anxious about it, are more aware of it, and tend to complain about it.”
In the wake of increased awareness of PTSD, a law was passed in 2009 to improve research of veterans’ pain issues and to require VA medical providers to use more “integrated” treatment approaches. Yet integrated treatment programs for injured veterans that go beyond just traditional physical therapy and painkillers, aren’t consistently available across the entire VA system. One former VA nurse testified last week that she was strong-armed into using prescription medication rather than non-prescriptive approaches, and that she was fired for voicing concerns over the opiate prescriptions. Also at the hearing, the VA Deputy Undersecretary for Health, Dr. Robert Jesse, promised to improve the opiate-prescription epidemic: “Whatever we can do to restore your trust in the VA, please give us a chance,” he said, appearing emotionally moved by the veterans’ testimony.
Over the summer, Senators Susan Collins, R-ME, and Richard Blumenthal, D-CT, introduced a bill to create a take-back program in which veterans can get rid of unused or unwanted prescription drugs, in the hopes of preventing substance abuse. (The legislation is co-sponsored by Senators Barbara Boxer, D-CA, and Lisa Murkowski, R-AK).
“(Rising prescription rates are) heart-wrenching proof that VA’s approach to pain management is failing and in need of an immediate overhaul,” said Rep. Jeff Miller, R-Fla., Chairman of the House Committee on Veterans’ Affairs. “The veteran patient and their loved ones must be listened to…and supported with a treatment plan that can best help them regain happy, healthy lives. Anything less is unacceptable.”
Tay Wiles is the online editor at High Country News. She Tweets @taywiles.