Killing Veterans With Painkillers

Our veterans' overdose death rate was 33% higher than average as VA doctors blithely prescribed opioid and other dangerous drugs. Some good changes are happening - but then there is stiff resistance from pill pushers.

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By Cameron Turner

05/19/14

SOURCE THE FIX

“Keeping our men and women 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 didn’t mince words last October when she testified before a House subcommittee investigating the stratospheric number of prescription drugs being given to American war veterans. McDonald’s husband, Army Spc. Scott McDonald, died in 2012 after accidentally overdosing on some of the eight pain medications and antidepressants he took daily for chronic pain and PTSD. Spc. McDonald was by no means alone. Pentagon data show that the number of pain pill prescriptions written by military doctors to service members quadrupled from 866,773 in 2001 to 3.8 million in 2009. Most of those meds were addictive opioid narcotics like oxycodone, hydrocodone, or methadone.

Vets had been dying from accidental overdoses at a rate 33 percent higher than that of civilians.

The consequences have been nightmarish. The number of veterans abusing or addicted to prescription drugs tripled between 2005 and 2008. And vets have been dying from accidental overdoses at a rate 33% higher than that of civilians. In 2010, the Army Suicide Prevention Task Force reported that alcohol or drugs were a factor in 29% of active duty Army suicides between 2005 and 2009. A third of those substance-related suicides involved prescription medications.

The Veterans Administration has been working to reverse those tragic trends with revised prescription guidelines introduced in 2009 and a new educational effort - the Opiate Safety Initiative - which launched in February of this year. But moving doctors and patients away from prescription drug therapies has proven to be an uphill battle. 

In 2008, 83% of soldiers being treated for chronic pain at the Warrior Clinic of the Walter Reed Army Medical Center in Washington were given prescription medication, primarily opioids. But by 2011, the number of Warrior Clinic patients who were prescribed narcotics had dropped to 10.2%. Since then, doctors at the Warrior Clinic have turned increasingly toward behavioral and non-medical approaches to pain management. 

"It's a holistic, interdisplinary, and multi-modal approach. Pain management is not simply giving opioids," says Dr. Christopher Spevak, a leading pain specialist at Walter Reed. Speaking to the US Army news site, Spevak explained, "We are very active in using acupuncture. That's a very big component of my practice (along with) chiropractic modalities. Through behavioral health we have specialized people that help with bio-feedback and even hypnosis." 

Multiple studies show that non-drug-based pain management programs are effective in reducing pain and staving off dependency. In 2008, researchers at the Mayo Clinic found that chronic pain patients who were weaned off of opioids as part of an interdisciplinary regimen experienced “significant and sustained improvement in pain severity and functioning.” In other words, they had less pain after they stopped taking painkillers. Last year the American Academy of Pain Medicine reported that nearly 80% of patients with chronic non-cancer pain remained opioid-free 12 months after completing an interdisciplinary rehab program that included opioid weaning.

These and other studies reinforce the message that the Veterans Administration is promoting through its Opiate Safety Initiative, a nationwide effort to educate veterans and their healthcare providers about the limitations and dangers of pain medication. Dr. Melissa L.D. Christopher, who directs the Initiative for California, Nevada and Hawaii, told a PBS reporter, “When opiates are used, they are not as effective as physical therapy, cognitive behavioral therapy and exercise for specific pain conditions.” 

But getting people to buy into that anti-drug message is often a tough sell. Part of the reason is economics; many insurance companies hesitate to cover non-drug treatments because they are more expensive than pills. But the deeper challenge is cultural. Relying on prescriptions to deal with discomfort has become an accepted, everyday practice among medical professionals and the public. Drug companies have fueled this trend with relentless TV advertising and promotional campaigns inside hospitals and medical schools. The result is what Barry Meier of the New York Times called “a synchronized drumbeat sounded by pharmaceutical companies, pain experts and others who argued that the drugs could defeat pain with little risk of addiction.”

Of course, the risk of addiction turned out to be much greater than the drum-beating prescription advocates estimated. This is especially true for military personnel, whose rate of prescription drug abuse (11%) is twice that of the civilian population (5%). 

Reducing that rate is one of the Veterans Administration’s goals. But many military doctors continue to prescribe pain meds heavily—and the pressure to write prescriptions can be intense. When she appeared before the House veterans’ affairs subcommittee last October, Dr. Pamela Gray testifiedthat she was terminated from the VA medical center in Hampton, Virginia after refusing to prescribe painkillers unnecessarily. Dr. Phyllis Hollenbeck told CBS News that her superiors at the Jackson, Mississippi VA demanded that she order prescriptions for patients that she had never met. 

Critics charge that such practices reflect a fragmented culture within the Veterans Administration. Tom Tarantino, chief policy officer for Iraq and Afghanistan Veterans of America, told the Center for Investigative Reporting that the VA is divided up into “fiefdoms where hospital directors are just running their own show out there.” 

Still, the VA is making progress in implementing its recommendations on reduced prescription use. Some hospitals report that they’re handing out fewer pain pills than they did in the past. Opioid prescriptions at the VA medical center in San Diego have taken a small but measurable drop from 18.2% to 17.2%. As she continues to promote the VA’s Opiate Safety Initiative, Dr. Melissa Christopher is optimistic that more physicians will replace drugs with integrated therapies in their effort to help veterans cope with chronic pain. “We want our veterans to live life in high definition and not be fogged by opiates. We want them to maintain control over their pain and transition to a better quality of life.”

Cameron Turner is a writer based in Los Angeles. He last wrote about sobriety and hip hop.