Archive for the ‘PTSD’ Category

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In a series of alarming reports, the V.A. and medical profession are beginning to wonder if treating PTSD with Opioid prescription drugs is the right course of action.   Referring to V.A. records, U.S. Medicine reports that “more than 141,000 Iraq and Afghanistan veterans have been diagnosed with non-cancer pain. The prevalence of PTSD among that group is 32%, with 19% diagnosed with other psychiatric disorders.”

Of this group, “11% have been prescribed opioids. For veterans with PTSD, that percentage grew to 17.8%. For other psychiatric illnesses, it’s 11.7%, with a 6.5% prescription rate for veterans with no psychiatric diagnoses.

U.S. Medicine goes on to report that “veterans with PTSD also were more likely to take higher opioid doses (22.7% vs. 15.9%), two or more opioids (19.8% vs. 10.7%) and concomitant sedative-hypnotic drugs (40.7% vs. 7.6%). Receiving prescription opioids was associated with adverse clinical outcomes for all veterans, but adverse effects were most pronounced in veterans with PTSD. Those outcomes included general wounds and injuries, accidents and overdoses, violent injuries and suicide attempts. While previous studies have shown that prescription opioids are more often prescribed for patients with psychiatric disorders, this trend was even more pronounced when the patient was diagnosed with PTSD.”

Lead author Karen Seal  of a recent study published in the Journal of the American Medical Association on the medication prescribed to veterans believes that the study results are troubling. ”The message to me is to keep redoubling our efforts to really have conversations with patients about these risks, and really provide them alternatives to just taking Vicodin or oxycodone or morphine, which has become very, very common in our society.”

It is becoming clear that our military leaders are now beginning to realize that these addictive drugs may, in fact, exacerbate the problems associated with PTSD rather than treat them.   In fact,  Bob Brewin of Veterans for Common Sense reports that  “the Army Surgeon General’s office is backing away from its long-standing endorsement of prescribing troops multiple highly addictive psychotropic drugs for the treatment of post-traumatic stress disorder and early this month warned regional medical commanders against using tranquilizers such as Xanax and Valium to treat PTSD.

“An April 10 policy memo that the Army Medical Command released regarding the diagnosis and treatment of PTSD said a class of drugs known as benzodiazepines, which include Xanax and Valium, could intensify rather than reduce combat stress symptoms and lead to addiction.

“The memo, signed by Herbert Coley, civilian chief of staff of the Army Medical Command, also cautioned service clinicians against prescribing second-generation antipsychotic drugs, such as Seroquel and Risperidone, to combat PTSD. The drugs originally were developed to treat severe mental conditions such as schizophrenia and bipolar disorder. The memo questioned the efficacy of this drug class in PTSD treatment and cautioned against their use due to potential long-term health effects, which include heart disorders, muscle spasms and weight gain.”

This greater awareness of the risk of prescribed opioids only confirms indications that SFTT has received from its sources “upwards of 80% of veterans suffering from PTSD also have an addiction problem.”     These new revelations are truly frightening and place a far greater sense of urgency in treating PTSD properly unless we plan on turning our brave veterans into addicts rather than cure them.

Daily, SFTT receives disturbing reports of the tragic consequences of post traumatic stress disorder (“PTSD”) among our brave warriors returning from the front lines of Afghanistan and Iraq.   With a returning veteran committing suicide every 80 minutes, the ongoing tragedy has triggered the well-deserved attention of investigative journalists, but it still does not resonate in the corridors of power, much less public opinion. This is an unfolding tragedy of our own making and – make no mistake – we will be living with the terrible consequences of our indifference and apathy for many years to come.

In a solid piece of investigative reporting, Australian journalist Nick Lazaredes takes another look at PTSD to see if anything has changed since his initial report in 2007. Sadly, it hasn’t; and for thousands veterans, their families and loved ones, the nightmare of our wars in Afghanistan and Iraq  continue to haunt our brave veterans.

SFTT reported earlier on some of the difficulties of treating veterans suffering from PTSD.  In fact, it would appear that many veterans abuse drugs and alcohol to cope with the trauma of PTSD.   The V.A., which is already swamped by veterans suffering from PTSD, does not appear to have the necessary resources to cope with the problem other than to prescribe drugs.  While these drugs may treat some of the symptoms of PTSD, most medical practitioners believe  that it rarely deals with the underlying trauma.  In short, we run the risk of having veterans suffering from PTSD becoming addicted to the very drugs that are used in treating them.

In fact, OxyContin often prescribed by the V.A. to deal with the symptoms of PTSD  has proven to be addictive and of questionable value in restoring our veterans to health.  Now, it has been known for sometime that OxyContin - which is manufactured by Purdue Pharma -  is an addictive drug often referred to as “Hillbilly Heroin” among other names.

OxyContin and other drugs of questionable therapeutic value are being administered by physicians to “treat” the symptoms of PTSD among our veterans.  While these drugs may be expedient at masking the symptoms of PTSD,  are we creating an even larger problem to rehabilitate our warriors?   Most of us at SFTT are convinced that this is a serious and growing problem.    SFTT feels strongly that our military and civilian leaders need to get in front of issue before it engulfs our ability to provide the proper treatment and care for our brave veterans.

We would like to thank Nick Lazaredes and SBS Australia for keeping this tragic story alive.

Last weekend, I had the privilege of visiting Warriors Salute in Rochester, NY which has an innovative and expanding program to treat veterans of our wars in Iraq and Afghanistan who suffer from PTSD.   I was fortunate to attend a training seminar hosted by Dr. Henry Grayson, Ph. D., for the clinical staff of Warriors Salute.  Dr. Grayson is the eminent psychologist who founded and directed the National Institute for the Psychotherapies in New York City and the author of Use Your Body to Heal Your Mind.    He is also a founding member of SFTT’s Medical Task Force to help address the large and growing problem of veterans suffering from PTSD.

While SFTT will report more on Dr. Grayson’s innovative approach to treating trauma, it is evident that there is no “magic bullet” to deal with the tragic consequences of veterans suffering from PTSD.  With at least 1 in 5 veterans who have served in Iraq and Afghanistan suffering from PTSD, the ongoing cost to our society is enormous.   Unfortunately, our military court system and the V.A. are structured in such a way that many veterans suffering from PTSD may be effectively deprived of proper treatment.

In a far-reaching report summarized by Howard Altman of the Tampa Tribune, Major Evan R. Seamone, a member of the Army’s Judge Advocate General’s Corps, argues that “courts-martial function as problem-generating courts when they result in punitive discharges that preclude mentally ill offenders from obtaining Veterans Affairs treatment. Such practices create a class of individuals whose untreated conditions endanger public safety and the veteran as they grow worse over time.”     In fact, Major Seamone’s 212 page report for the Military Law Journal may be accessed by clicking on this hyperlink:   The Military Court system and PTSD.

Major Seamone’s observations are clearly “on-target” when it comes to dealing with veterans suffering from PTSD.  Many – if not most – veterans who suffer from PTSD also have a substance abuse problem.   In fact, one experienced addiction specialist suggested that “upwards of 80% of veterans suffering from PTSD also have an addiction problem.”   Unfortunately, the V.A. and our military courts tend to address PTSD and substance abuse as separate issues thereby depriving large numbers of veterans with the comprehensive treatment they deserve.   Sadly, substance abuse is a common opiate for those that suffer from combat-related trauma.

Since the mid-1990, the US judicial system has recognized the need to deal with drug-related criminal activity and have established some 2,600 Drug Treatment Courts in the United States.  Drug treatment courts are specialized community courts designed to help stop the abuse of drugs, alcohol, and related criminal activity. Non-violent offenders who have been charged with simple possession of drugs are given the option to receive treatment instead of a jail sentence.   These programs have proven to be remarkably successful for reducing the level of recidivism in our prison system.

Capitalizing on the infrastructure and success of the Drug Treatment Courts, some 50 or so Veteran Courts have sprung up across the United States to deal with veterans who have committed a crime while suffering from substance abuse.  In many cases, these troubled vets have the support of other Vets (often from the Vietnam era) who “mentor” their military colleagues through the rehabilitation process.   Judge John Schwartz,  one of the early pioneers in the Vet Court system, said that “We offer hope to these troubled veterans who have served our country so valiantly.  It’s simply common sense.”

When communities reach out to help these brave warriors, our society is enriched. From our perspective, it’s simply a matter of doing the right thing!  We owe these brave young men and women big time!

Richard W. May

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