An article appeared in today's Wall Street journal about a Marine veteran who had overdosed twice on opioid painkillers prescribed for a hand injury suffered in Iraq. After a week of withdrawal, he checked himself out of a VA hospital, and was given 168 pills of the same drug to which he had been addicted. The following day, he was given another 168 pills.
The article pointed out that many of the more than two million Americans who served in Iraq or Afghanistan suffer from a combination of physical pain (from various injuries) and PTSD (Post-traumatic Stress Disorder). The VA treats many of them with powerful opioid painkillers which make for a high risk of addiction in these vulnerable veterans.
In one case (detailed in the WSJ article), the VA had prescribed more than 3,600 oxycodone tablets to one veteran over the three years between 2008 and 2011. This single veteran overdosed on the medication six times. At one point, he no longer wanted to live and became briefly homicidal. (This raises the specter of yet another mass shooting.)
The article pointed out that some 30 percent of Iraq and Afghanistan veterans under VA care suffer from PTSD, and more than half experience chronic pain from war injuries. Last year, more than 50,000 veterans were treated by the VA for problems associated with opioid use, nearly double the figure from a decade ago.
In essence, these highly addictive medications are being prescribed to veterans in an effort to relieve physical pain, and temporarily relieve (by sedation) their serious mental conditions. Their mental and emotional states, by themselves, often heighten their perceptions of physical pain.
Many veterans with PTSD and pain issues take excessive amounts of narcotic painkillers to numb themselves from their nightmares, flashbacks and from free-floating anxiety, all part of Post-traumatic Stress Disorder deriving from their combat experiences.
In addition to the horror of opioid addiction, VA physicians also prescribe benzodiazepines such Klonopin and Ativan. These medications are also highly addictive. One need take them for a mere 30 days for tolerance and withdrawal symptoms to develop.
To make matters worse, not only do these medications require increasing doses to maintain anti-anxiety effects, but they are not FDA approved for treating Post-traumatic Stress Disorder. In fact, they are completely inappropriate because of their addictive qualities and because they don't effectively address the target symptoms of PTSD. There are classes of medications approved by the FDA (the SSRIs and SNRIs) for treating PTSD. In addition, there are non-narcotic treatment options available for controlling physical pain.
The "treatment" provided our veterans not only fails to help them, but creates the burden of addiction with its attendant psychic and social concerns--superimposed on smoldering PTSD. "Unfortunately, it is typical," among vets with PTSD and pain issues, said Reza Ghorbani, medical director of the Advanced Pain Medicine Institute near Washington, D.C. "It's the wrong way of treating a patient."
As a physician and psychiatrist, I must say this: not only does our mental health system need an overhaul, but our veterans' treatment is out of touch with the latest developments in mental health treatments. Our government is creating a population of war-torn addicts who will limp through the rest of their lives with the debilitating stigmata of drug and alcohol addiction; chronic pain; and the erosive effects of PTSD.
This is the truly sad aftermath of battle.
Mark Rubinstein, M.D.
Author of Mad Dog House and Love Gone Mad