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Painkiller prescriptions skyrocket, endangering veterans

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Tay Wiles | Oct 17, 2013 07:00 AM

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.

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The circles indicate increases in number of opiate painkiller prescriptions given by Veterans Affairs providers between 2001 and 2012. Image from Center for Investigative Reporting.

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.

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A Veterans Affairs hospital in Oregon led the nation in highest number of prescriptions of opiate painkillers per patients last year. Veterans around the country are being prescribed more painkillers now than ever before.

“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.

Tom Schweich
Tom Schweich
Oct 17, 2013 04:49 PM
Nicely written article. Typically, when reading an article about this subject, I'm left feeling there is something missing the discussion along the axis of: medication for pain, to self-medication for physical and/or psychological pain, to DRUG ABUSE. Can't put my finger on it precisely, maybe it's just a hangover from the Drug War, or maybe something more subtle(?).
David Winnett
David Winnett
Oct 17, 2013 06:57 PM
As a 100% disabled Persian Gulf War Veteran afflicted with Chronic Fatigue Syndrome, Peripheral Neuropathy, Fibromyalgia and several other neurologically rooted disorders, I have been through the laundry list of medications most widely prescribed for these conditions (Lyrica, Gabapentin, etc.). Long story short - for me these drugs do not work. Worse yet, they cause very bothersome foggy headedness, and severe degradation of my mental acuity. They make me feel like a zombie.

I have discovered through personal long term experience that the ONLY medications that allow me to remain alert, clear-headed, and somewhat functional are Hydrocodone (Vicodin) for my body-wide muscle pain, Clonazapam (to control severe muscle twitching), and Concerta, a time-release form of Ritalin that helps to offset my profound fatigue.

Without the painkiller (Vicodin), I experience constant severe body-wide pain and profound fatigue. Without those three drugs to control my most debilitating symptoms, I am literally bedridden.

What purpose would it serve to deny me the only medications that have proven to provide me with relief from these life-altering conditions? Why should I be penalized because of the abuse the VA has observed in others? To be denied pain medication is to bring an end to the relatively little normalcy I have been able to achieve through these drugs over the past two decades.

Until ongoing Gulf War Illness research leads to more targeted and effective medical protocols for those of us afflicted by Gulf War Illness, I would appeal to the VA to use common sense by dealing with the cases of narcotics abuse as warranted, but don't throw the baby out with the bath water by implementing a draconian policy that denies pain medications to those of us who benefit from them, and use them as directed by our doctors.

Semper Fidelis,
David K. Winnett, Jr.
Captain, USMC (Ret.)
Alvin Pritchard
Alvin Pritchard
Oct 17, 2013 08:47 PM
Denying Veterans the medication that they need constitutes as a dereliction of care.
Veterans are NOT the enemy of the state and i find it most perplexing as to why they appear to be treated as such.

I have observed that veterans are being treated like second class citizens in their own country by way of such denial.

 Portraying veterans as being untrustworthy and made to wait unreasonable long times for rating assessments ect is simply unacceptable.

You don't have to dig too deep to establish the fact that it is the nations veterans who provided the freedoms and liberty's that citizens takes so much for granted on a daily basis.

The very least the nation can do is to give some recompense and show some respect by offering a prompt first class service in their time of genuine need, for if the nation fails to do so, it should hang it's head in shame.
Gale Reid
Gale Reid
Oct 17, 2013 10:54 PM
I, too, am a disabled Gulf War Veteran. It saddens me to think that the VA and this gov't is basing its medical policies based on behavior of a few veterans and/or the doctor's mismanagement of prescriptions, instead of what the veterans medical needs are.

I have a medical background and have also worked in the VA hospital. I have had to use some form of pain medication ever since returnin from the Gulf War to treat my conditions that are a result of that toxic war. It's bad enough that we have had to fight for recognition of our conditions that came from that war and also had to fight for research to treat us. Our gov't failed us when they denied we were even exposed to anything in the early years, thus, leave us to fend for our own medical care and relief of pain. We were diagnosed as "psychosomatic" for several years because the gov't didn't want to acknowledge what a cesspool of toxins we were subject to there. It was much easier to just label us with PTSD and say that it was all in our heads.

The 2008 Gulf War Research Advisory Committee Report FINALLY came through for us, acknowledging the exposures and history of what we endured as sick soldiers and veterans: http://www.va.gov/[…]/GWIandHealthofGWVeterans_RAC-GWVIReport_2008.pdf

I find it wreckless to report and punish the sick veterans with knee-jerk reactions in medication policies-- some of which boils down to nothing more than circumventing the cost of pain medications.

Soldiers and veterans were promised healthcare for life for risking their lives for this country. We now see a decline in the VA's interest to adequately care for us. And we currently saw where veterans were used as pawns in the recent fight over federal budget cuts. Where is the moral backbone in our leaders in gov't and healthcare? We, as veterans lived up to our promise to this country to protect it, however, our politicians and VA are not living up to theirs! If veterans have tried every pain medication on the market and yet find relief only in the opiads that help them to function and not to become bedridden, then GIVE IT TO THEM if it's medically necessary!! We're tired of having to fight one war overseas, then coming home to fight another war in getting our exposures recognized and another war in getting the healthcare we were promised.

I've also come to doubt these reports, the means of gathering data, and how they come to their decisions. We've seen the IOM make horrible decisions and findings relating to our exposures based on (their terms) "lack of information". Before reporting these kinds of issues, please provide the CIR's full report-- not just cherry pick numbers from one area of the nation. You do us a gross disfavor by this. This article seems to have a couple of issues with reporting veterans' use of some pain medications... Is it the mismanagement by providers? Is it the misuse by veterans? Is it the overall cost of adequate healthcare? Or, is it a smear campaign to make veterans seem like a bunch of irresponsible psychos (because that's what we're being made out to look like here)? I assure you we are big boys and girls who are able to determine and evaluate the risks we take in our lives-- whether it's in the battlefield or in the doctor's office.

Gale Reid
USAF, Ret
100% DAV Service-connected
Deb Dedon
Deb Dedon Subscriber
Oct 22, 2013 08:40 PM
I don't believe that the opiate OD trend is confined to the military; the higher rates just might be due to the type of injuries survived over multiple deployments. What used to kill soldiers now merely grants them a lifetime of pain.
Terry Watt
Terry Watt
Oct 23, 2013 12:51 AM
I don't suppose our veterans are given the option of trying non-addictive, impossible to overdose on, medical marijuana for pain and other problems?
kimberly green
kimberly green
Oct 23, 2013 07:28 AM
Just because it can...


Promises of free care, its a token
The Soldier reups, his body soon will become broken
Broken down old at such a young age
The soldier lives his life, while building a rage
The rage comes full circle, as the V.A. begins its plan
To kill off its soldiers just because it can
More pills to give forget the cure
Just give more pills, they will die for sure
Forget that he is a Desert Storm Vet
Memories of that time cant be swept
Just give another pill, not one but three
Until he can't walk, but must hold onto a tree
Three becomes six. give another to the old man
More and more just because you can
Death comes to the young old man
The V.A. never falters just because it can
Forsake not my Desert Storm Vet run while you can
For I will take the stand
No MORE!! something will be done
NO MORE!! dying of Americas young
The V.A. must answer ....but...then again
Most likely it will lie in squander just because it can


Written by Kimberly Green
dedicated to her Desert Storm Vet SFC Ricky W. Green

Jan 5 201






Promises of free care, its a token
The Soldier reups, his body soon will become broken
Broken down old at such a young age
The soldier lives his life, while building a rage
The rage comes full circle, as the V.A. begins its plan
To kill off its soldiers just because it can
More pills to give forget the cure
Just give more pills, they will die for sure
Forget that he is a Desert Storm Vet
Memories of that time cant be swept
Just give another pill, not one but three
Until he can't walk, but must hold onto a tree
Three becomes six. give another to the old man
More and more just because you can
Death comes to the young old man
The V.A. never falters just because it can
Forsake not my Desert Storm Vet run while you can
For I will take the stand
No MORE!! something will be done
NO MORE!! dying of Americas young
The V.A. must answer ....but...then again
Most likely it will lie in squander just because it can
























































Joel Smith
Joel Smith
Nov 04, 2013 04:21 PM
every veteran, on opiates, should weigh the issue of taking the medication to maintain a somewhat normal life compared to living day to day in pain. Due to a plate in my neck, from multiple neck fusions, a paralyzed left leg, from shrapnel injury, i decided years ago that i had to take the opiates to function. I am still trying to work and not become totally dependent on the VA for compensation. Apparently all the publicity, on this topic, has caused my VA doctor to cut off my medication. What do i do? I learned years ago that it is impossible to work and cope without the opiates. that is why i decided to start taking them. I do not take more than prescribed (3 tablets per day) and have never abused the medication. I just realized that to lead a somewhat normal and productive life I had to take them( I was reluctant at first). So what now? What gets me is the knee jerk reaction to a few cases were the loved ones should have been paying attention to the amounts of medication that was being taken. How many of the vets abused their medications? So i guess I can sit home from work now, limp on up to my local Va office and request 100% unemployable status?

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